Provider Demographics
NPI:1922802297
Name:MARTINEZ MADRID, ERICK EDUARDO (DDS)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:EDUARDO
Last Name:MARTINEZ MADRID
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 DUSK VIEW ST. UNIT A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79927
Mailing Address - Country:US
Mailing Address - Phone:915-215-9491
Mailing Address - Fax:
Practice Address - Street 1:AGUAS CALIENTES #1632
Practice Address - Street 2:
Practice Address - City:CD.JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32599
Practice Address - Country:MX
Practice Address - Phone:915-215-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ141097471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty