Healthcare Provider Details

I. General information

NPI: 1639596463
Provider Name (Legal Business Name): DANIEL MARTIR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 CALLE LAS CAISEAS
MAYAGUEZ PR
00682-5965
US

IV. Provider business mailing address

8350 TAVERN PT
SAN ANTONIO TX
78254-5579
US

V. Phone/Fax

Practice location:
  • Phone: 787-319-8061
  • Fax:
Mailing address:
  • Phone: 787-319-8061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number33738
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number33738
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3165
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: