MEDICARE: L MARTINEZ P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1679051296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L MARTINEZ P C

Provider Business Mailing Address
First Line	:	4308 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4338
Country	:	US
Telephone Number	:	773-522-2929
Fax Number	:

Provider Business Practice Location Address
First Line	:	6144 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-4628
Country	:	US
Telephone Number	:	773-522-2929
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LETICIA MARTINEZ
Credential	:	DDS
Telephone Number	:	773-522-2929

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	08/06/2018

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Directions to “L MARTINEZ P C ” Practice Location

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