Provider Demographics
NPI:1003969742
Name:MARTIN, ROBERT DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:MARTIN
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 1:1107 FARMINGTON LANE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON C H
Mailing Address - State:OH
Mailing Address - Zip Code:43160
Mailing Address - Country:US
Mailing Address - Phone:740-335-1722
Mailing Address - Fax:740-335-8989
Practice Address - Street 1:3 COMMERCIAL AVENUE
Practice Address - Street 2:
Practice Address - City:WASHINGTON C H
Practice Address - State:OH
Practice Address - Zip Code:43160
Practice Address - Country:US
Practice Address - Phone:740-335-7007
Practice Address - Fax:740-335-8989
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist