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General NPI Number Information
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NPI Number | 1003964040
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Entity Type | Organization
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Legal Business Name | SUSAN MARTINEZ D.D.S. P.A.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 13419 SW 56TH ST
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City | MIAMI
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State | FL
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Zip | 33175-6117
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Country | US
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Telephone | 305-559-2663
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Fax | 305-559-3040
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Provider Business Mailing Address
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Address Line | 13419 SW 56TH ST
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City | MIAMI
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State | FL
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Zip | 33175-6117
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Country | US
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Telephone | 305-559-2663
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Fax | 305-559-3040
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSANA MARTINEZ
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Credential | D.D.S.
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Telephone | 305-559-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN0013120
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License Number State | FL
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