Provider Demographics
NPI:1528125010
Name:MARTINEZ, LUIS E (DMD PA)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1020
Mailing Address - Country:US
Mailing Address - Phone:727-526-3868
Mailing Address - Fax:
Practice Address - Street 1:3770 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1020
Practice Address - Country:US
Practice Address - Phone:727-526-3868
Practice Address - Fax:727-527-1921
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDEN 105681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice