Individual
AMANDA LEE MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 W NAVAJO ST, WEST LAFAYETTE, IN 47906-1999
(765) 463-5437
Mailing address
520 W NAVAJO ST, WEST LAFAYETTE, IN 47906-1999
(765) 463-5437
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12013374A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300038906
—
IN
Enumeration date
04/13/2020
Last updated
06/25/2025
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