Healthcare Provider Details

I. General information

NPI: 1003964040
Provider Name (Legal Business Name): SUSAN MARTINEZ D.D.S. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13419 SW 56TH ST
MIAMI FL
33175-6117
US

IV. Provider business mailing address

13419 SW 56TH ST
MIAMI FL
33175-6117
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-2663
  • Fax: 305-559-3040
Mailing address:
  • Phone: 305-559-2663
  • Fax: 305-559-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN0013120
License Number StateFL

VIII. Authorized Official

Name: DR. SUSANA MARTINEZ
Title or Position: OWNER
Credential: D.D.S.
Phone: 305-559-2663