Healthcare Provider Details

I. General information

NPI: 1245605740
Provider Name (Legal Business Name): MELINA MARTINEZ DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BOTULPH RD
SANTA FE NM
87505-5730
US

IV. Provider business mailing address

2010 BOTULPH RD
SANTA FE NM
87505-5730
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-1312
  • Fax: 505-983-8170
Mailing address:
  • Phone: 505-983-1312
  • Fax: 505-983-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MELINA LUJAN MARTINEZ
Title or Position: OWNER
Credential: DMD
Phone: 505-983-1312