Healthcare Provider Details

I. General information

NPI: 1831463017
Provider Name (Legal Business Name): JOSE MA MARTINEZ DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 302
JACKSONVILLE FL
32216-6282
US

IV. Provider business mailing address

6817 SOUTHPOINT PKWY STE 302
JACKSONVILLE FL
32216-6282
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-6820
  • Fax:
Mailing address:
  • Phone: 904-296-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13951
License Number StateFL

VIII. Authorized Official

Name: JOSE M MARTINEZ
Title or Position: OWNER/PRESIDENT
Credential: DMD
Phone: 904-296-6820