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General NPI Number Information
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NPI Number | 1437643855
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Entity Type | Individual
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Provider Name | ANDREA MARTINEZ DMD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 4731 E SOUTHERN AVE
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City | PHOENIX
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State | AZ
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Zip | 85042-4150
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Country | US
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Telephone | 602-481-4478
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 N CITRUS RD
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City | GOODYEAR
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State | AZ
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Zip | 85395-9204
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D010058
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License Number State | AZ
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