Provider Demographics
NPI:1003894536
Name:MARTIN, C. ALLEN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:C.
Middle Name:ALLEN
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:801 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE D
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2923
Mailing Address - Country:US
Mailing Address - Phone:251-344-6191
Mailing Address - Fax:251-344-6794
Practice Address - Street 1:801 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE D
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2923
Practice Address - Country:US
Practice Address - Phone:251-344-6191
Practice Address - Fax:251-344-6794
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL453370OtherUNITED CONCORDIA
AL94321OtherBCBS
AL94321OtherBCBS