Provider Demographics
NPI:1053889147
Name:MARTIN DENTAL PC
Entity type:Organization
Organization Name:MARTIN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-650-9929
Mailing Address - Street 1:21152 E RITTENHOUSE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4964
Mailing Address - Country:US
Mailing Address - Phone:480-650-9929
Mailing Address - Fax:
Practice Address - Street 1:21152 E RITTENHOUSE RD STE 106
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4964
Practice Address - Country:US
Practice Address - Phone:480-650-9929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental