Provider Demographics
NPI:1073181939
Name:MARTIN, JENNIFER AUDREY (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AUDREY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 S WOODS RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-3128
Mailing Address - Country:US
Mailing Address - Phone:973-879-4893
Mailing Address - Fax:
Practice Address - Street 1:485 AMWELL RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-8213
Practice Address - Country:US
Practice Address - Phone:908-359-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0431671223G0001X
NJ22DI028446001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice