Healthcare Provider Details

I. General information

NPI: 1841940186
Provider Name (Legal Business Name): ANDRES MARTINEZ PORRAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 AUGUSTA DR STE 276
HOUSTON TX
77057-4922
US

IV. Provider business mailing address

7500 SAN FELIPE ST STE 325
HOUSTON TX
77063-1700
US

V. Phone/Fax

Practice location:
  • Phone: 346-487-8216
  • Fax: 346-487-8216
Mailing address:
  • Phone: 346-487-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number38891
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: