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General NPI Number Information
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NPI Number | 1932709987
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Entity Type | Individual
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Provider Name | RUBEN DARIO MARTIN JR.
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Gender | Male
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 791 TOWN AND COUNTRY BLVD STE 222
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City | HOUSTON
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State | TX
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Zip | 77024-3978
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Country | US
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Telephone | 832-742-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 230 T C JESTER BLVD APT 306
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City | HOUSTON
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State | TX
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Zip | 77007-3278
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Country | US
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Telephone | 786-830-8979
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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 | 122400000X
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Taxonomy Name | Denturist
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License Number | DL14578
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 40232
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License Number State | TX
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