Provider Demographics
NPI:1043480940
Name:MARTINEZ, LYDA (DDS)
Entity type:Individual
Prefix:DR
First Name:LYDA
Middle Name:
Last Name:MARTINEZ
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 1:4550 CHERRY CREEK SOUTH DR APT 501
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1540
Mailing Address - Country:US
Mailing Address - Phone:303-455-2273
Mailing Address - Fax:303-455-6053
Practice Address - Street 1:4450 W 38TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2077
Practice Address - Country:US
Practice Address - Phone:303-455-2273
Practice Address - Fax:303-455-6053
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist