MEDICARE: MELINA MARTINEZ DMD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1245605740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELINA MARTINEZ DMD LLC

Provider Business Mailing Address
First Line	:	2010 BOTULPH RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5730
Country	:	US
Telephone Number	:	505-983-1312
Fax Number	:	505-983-8170

Provider Business Practice Location Address
First Line	:	2010 BOTULPH RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5730
Country	:	US
Telephone Number	:	505-983-1312
Fax Number	:	505-983-8170

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MELINA LUJAN MARTINEZ
Credential	:	DMD
Telephone Number	:	505-983-1312

Provider Enumeration Date	:	12/09/2015
Last Update Date	:	12/09/2015

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