Healthcare Provider Details

I. General information

NPI: 1720086515
Provider Name (Legal Business Name): ORLANDO R. MARTIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2RR471 VIA 1 VILLA FONTANA
CAROLINA PR
00983-3857
US

IV. Provider business mailing address

2RR471 VIA 1 VILLA FONTANA
CAROLINA PR
00983-3857
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-7617
  • Fax:
Mailing address:
  • Phone: 787-750-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1916
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: