Provider Demographics
NPI:1013037035
Name:METZGER, MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:METZGER
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 1:55 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-1035
Mailing Address - Country:US
Mailing Address - Phone:401-781-5610
Mailing Address - Fax:401-781-5622
Practice Address - Street 1:55 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-1035
Practice Address - Country:US
Practice Address - Phone:401-781-5610
Practice Address - Fax:401-781-5622
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDNT 18331223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics