MEDICARE: DR. PATRICIA ELAINE MARTIN DDS

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	33194	TX
2	1223G0001X	General Practice Dentistry	DD4732	NM

General Provider Information

NPI Number	:	1992205777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA ELAINE MARTIN DDS

Provider Business Mailing Address
First Line	:	705 E UNIVERSITY AVE STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5637
Country	:	US
Telephone Number	:	505-521-0127
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 E UNIVERSITY AVE STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5637
Country	:	US
Telephone Number	:	575-521-0127
Fax Number	:	575-521-0127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2018
Last Update Date	:	10/01/2024

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