MEDICARE: DR. MELINA LUJAN MARTINEZ D.M.D.

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	5885	NV

General Provider Information

NPI Number	:	1467696013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELINA LUJAN MARTINEZ D.M.D.

Provider Business Mailing Address
First Line	:	3769 TRANQUILITY RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7702
Country	:	US
Telephone Number	:	702-994-4299
Fax Number	:	702-360-3426

Provider Business Practice Location Address
First Line	:	3769 TRANQUILITY RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7702
Country	:	US
Telephone Number	:	702-994-4299
Fax Number	:	702-360-3426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	04/27/2009

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