Provider Demographics
NPI:1649207259
Name:MARTINEZ-RIVERA, CARMELO (DMD)
Entity type:Individual
Prefix:DR
First Name:CARMELO
Middle Name:
Last Name:MARTINEZ-RIVERA
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:BB-25 SANTA JUANITA AVE.
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-787-9043
Mailing Address - Fax:787-786-5260
Practice Address - Street 1:BB25 AVE SANTA JUANITA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4633
Practice Address - Country:US
Practice Address - Phone:787-787-9043
Practice Address - Fax:787-786-5260
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD0685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist