=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649207259
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMELO MARTINEZ-RIVERA D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2006
-----------------------------------------------------
Last Update Date | 01/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BB25 AVE SANTA JUANITA
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00956-4633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-787-9043
-----------------------------------------------------
Fax | 787-786-5260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BB-25 SANTA JUANITA AVE.
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-787-9043
-----------------------------------------------------
Fax | 787-786-5260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D0685
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------