Healthcare Provider Details

I. General information

NPI: 1447618244
Provider Name (Legal Business Name): MARTINEZ ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 S RAINBOW BLVD STE 103
LAS VEGAS NV
89118-2530
US

IV. Provider business mailing address

5775 S RAINBOW BLVD STE 103
LAS VEGAS NV
89118-2530
US

V. Phone/Fax

Practice location:
  • Phone: 702-979-9799
  • Fax: 702-979-9823
Mailing address:
  • Phone: 702-979-9799
  • Fax: 702-979-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-256
License Number StateNV

VIII. Authorized Official

Name: DR. FREDDIE MARTINEZ
Title or Position: OWNER
Credential: DDS, MS
Phone: 702-979-9799