Provider Demographics
NPI:1053620302
Name:HUICOCHEA MARTINEZ, CARLOS MIGUEL (DDS)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:MIGUEL
Last Name:HUICOCHEA MARTINEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4619
Mailing Address - Country:US
Mailing Address - Phone:972-298-2027
Mailing Address - Fax:724-768-6269
Practice Address - Street 1:427 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4619
Practice Address - Country:US
Practice Address - Phone:972-298-2027
Practice Address - Fax:724-768-6269
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277531223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2944068Medicaid