MEDICARE: MARTINEZ ORTHODONTICS 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	S3-256	NV

General Provider Information

NPI Number	:	1447618244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTINEZ ORTHODONTICS LLC

Provider Business Mailing Address
First Line	:	5775 S RAINBOW BLVD
Second Line	:	STE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2530
Country	:	US
Telephone Number	:	702-979-9799
Fax Number	:	702-979-9823

Provider Business Practice Location Address
First Line	:	5775 S RAINBOW BLVD
Second Line	:	STE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2530
Country	:	US
Telephone Number	:	702-979-9799
Fax Number	:	702-979-9823

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FREDDIE MARTINEZ
Credential	:	DDS, MS
Telephone Number	:	702-979-9799

Provider Enumeration Date	:	02/08/2016
Last Update Date	:	02/08/2016

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