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General NPI Number Information
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NPI Number | 1831463017
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Entity Type | Organization
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Legal Business Name | JOSE MA MARTINEZ DMD PA
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 6817 SOUTHPOINT PKWY STE 302
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6282
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Country | US
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Telephone | 904-296-6820
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Fax |
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Provider Business Mailing Address
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Address Line | 6817 SOUTHPOINT PKWY STE 302
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6282
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Country | US
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Telephone | 904-296-6820
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JOSE M MARTINEZ
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Credential | DMD
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Telephone | 904-296-6820
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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 | 13951
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License Number State | FL
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