Individual
TYLER E MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3 MORA VALLEY CLINIC RD, MORA, NM 87732-2202
(505) 387-2201
Mailing address
PO BOX 209, MORA, NM 87732-0209
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD5299
NM
Other
Enumeration date
07/16/2020
Last updated
07/29/2020
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