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General NPI Number Information
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NPI Number | 1629678602
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Entity Type | Organization
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Legal Business Name | ANDREA MARTINEZ LLC
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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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 | 1423 E YUCCA ST
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City | PHOENIX
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State | AZ
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Zip | 85020-1424
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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 | OWNER DOCTOR
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Name | ANDREA MARTINEZ
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Credential | DMD
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Telephone | 602-481-4478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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