Provider Demographics
NPI:1487662144
Name:PADIN-MARTINEZ, LIZETTE MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:LIZETTE
Middle Name:MARIA
Last Name:PADIN-MARTINEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-4589
Mailing Address - Country:US
Mailing Address - Phone:800-498-8792
Mailing Address - Fax:765-677-5156
Practice Address - Street 1:1700 E 38TH ST
Practice Address - Street 2:(160)
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4568
Practice Address - Country:US
Practice Address - Phone:800-498-8792
Practice Address - Fax:765-677-5156
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist