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General NPI Number Information
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NPI Number | 1962954545
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Entity Type | Individual
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Provider Name | ALYSSA MARTINI DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 01/01/2017
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Provider Practice Location Address
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Address Line | 3302 GASTON AVE TEXAS A&M UNIVERSITY COLLEGE OF DENTISTRY
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City | DALLAS
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State | TX
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Zip | 75246-2013
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Country | US
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Telephone | 404-354-7443
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Fax |
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Provider Business Mailing Address
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Address Line | 2627 LIVE OAK ST #14028
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City | DALLAS
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State | TX
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Zip | 75204-5700
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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 | 32508
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License Number State | TX
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