MEDICARE: RUBEN DARIO MARTIN JR.

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	122400000X	Denturist	DL14578	MA
2	1223P0300X	Periodontics	40232	TX

General Provider Information

NPI Number	:	1932709987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN DARIO MARTIN JR.

Provider Business Mailing Address
First Line	:	230 T C JESTER BLVD APT 306
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3278
Country	:	US
Telephone Number	:	786-830-8979
Fax Number	:

Provider Business Practice Location Address
First Line	:	791 TOWN AND COUNTRY BLVD STE 222
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-3978
Country	:	US
Telephone Number	:	832-742-0515
Fax Number	:

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

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	03/18/2024

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