Provider Demographics
NPI:1730278052
Name:MARTINEZ, MAURICIO (DMD)
Entity type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 SW 51ST TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7058
Mailing Address - Country:US
Mailing Address - Phone:239-549-0001
Mailing Address - Fax:
Practice Address - Street 1:1519 SE 47TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9637
Practice Address - Country:US
Practice Address - Phone:239-549-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16390332B00000X, 1223G0001X
FL16390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1223G0001XDental ProvidersDentistGeneral Practice