Provider Demographics
NPI:1487705307
Name:MARTINEZ, PEDRO JAVIER (DMD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:JAVIER
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 LAKE POLO DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1700
Mailing Address - Country:US
Mailing Address - Phone:813-785-9807
Mailing Address - Fax:727-372-5022
Practice Address - Street 1:8532 OLD CR 54
Practice Address - Street 2:GREENBROOK PLAZA
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653
Practice Address - Country:US
Practice Address - Phone:727-372-9669
Practice Address - Fax:727-372-5022
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice