Provider Demographics
NPI:1730176157
Name:MARTIN, MYRA VALDEZ (DDS)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:VALDEZ
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 CLUB HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8073
Mailing Address - Country:US
Mailing Address - Phone:757-410-9681
Mailing Address - Fax:
Practice Address - Street 1:USS THEODORE ROOSEVELT
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:09599-2871
Practice Address - Country:US
Practice Address - Phone:757-444-5987
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190263261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice