Provider Demographics
NPI:1366884801
Name:LUIS E. MARTINEZ, D.M.D., P.A.
Entity type:Organization
Organization Name:LUIS E. MARTINEZ, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PA
Authorized Official - Phone:727-526-3868
Mailing Address - Street 1:3770 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1020
Mailing Address - Country:US
Mailing Address - Phone:727-526-3868
Mailing Address - Fax:727-527-1921
Practice Address - Street 1:3770 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1020
Practice Address - Country:US
Practice Address - Phone:727-526-3868
Practice Address - Fax:727-527-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty