MEDICARE: DR. CAITILIN RENEE MARTINI 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	332B00000X	Durable Medical Equipment & Medical Supplies	DN0013463	FL
2	1223G0001X	General Practice Dentistry	DN0013463	FL

General Provider Information

NPI Number	:	1629118716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAITILIN RENEE MARTINI D.M.D.

Provider Business Mailing Address
First Line	:	3502 W BAY TO BAY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7045
Country	:	US
Telephone Number	:	813-839-6999
Fax Number	:	813-831-1670

Provider Business Practice Location Address
First Line	:	3502 W BAY TO BAY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7045
Country	:	US
Telephone Number	:	813-839-6999
Fax Number	:	813-831-1670

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/02/2019

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