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General NPI Number Information
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NPI Number | 1295523850
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Entity Type | Individual
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Provider Name | MATHIAS ALFREDO JOSE MARTINEZ CORONEL
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Gender | Male
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1605 TOWN CENTER BLVD STE B
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City | WESTON
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State | FL
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Zip | 33326-3637
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Country | US
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Telephone | 954-389-0511
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Fax |
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Provider Business Mailing Address
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Address Line | 181 THORNELL RD
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City | PITTSFORD
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State | NY
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Zip | 14534-3629
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Country | US
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Telephone | 585-309-5245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN30144
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License Number State | FL
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