Healthcare Provider Details

I. General information

NPI: 1184439366
Provider Name (Legal Business Name): MARTIN ALEJANDRO GIRON PALACIOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMPILLO 86 SUITE A
NOGALES SONORA
84000
MX

IV. Provider business mailing address

PO BOX 1244
NOGALES AZ
85628-1244
US

V. Phone/Fax

Practice location:
  • Phone: 631-312-4055
  • Fax:
Mailing address:
  • Phone: 520-270-0962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTIN ALEJANDRO GIRON PALACIOS
Title or Position: DENTIST
Credential: DDS
Phone: 520-270-0962