Healthcare Provider Details

I. General information

NPI: 1790603959
Provider Name (Legal Business Name): JOSE OMAR MARTES MARTINEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE AMERICO MIRANDA
SAN JUAN PR
00921
US

IV. Provider business mailing address

839 CALLE ANASCO PLAZA UNIVERSIDAD 2000, APT 1807
SAN JUAN PR
00925
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone: 787-617-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: