Healthcare Provider Details

I. General information

NPI: 1730921347
Provider Name (Legal Business Name): ANDREA MARTINEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 113TH ST
SEMINOLE FL
33772-2800
US

IV. Provider business mailing address

8405 DUNHAM STATION DR
TAMPA FL
33647-3339
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-5050
  • Fax:
Mailing address:
  • Phone: 813-407-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDRPM2767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: