Healthcare Provider Details

I. General information

NPI: 1821106311
Provider Name (Legal Business Name): HAROLD JOSE MARTINEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 E PARHAM RD SUITE A
RICHMOND VA
23228
US

IV. Provider business mailing address

3107 HUNGARY SPRING RD
RICHMOND VA
23228-2421
US

V. Phone/Fax

Practice location:
  • Phone: 804-501-0501
  • Fax: 804-501-0509
Mailing address:
  • Phone: 804-501-0501
  • Fax: 804-501-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401410241
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: