Provider Demographics
NPI:1083792634
Name:MARTZ, JEFFREY WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:MARTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:118 BITTERSWEET CIR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1000
Mailing Address - Country:US
Mailing Address - Phone:412-996-0889
Mailing Address - Fax:724-260-0044
Practice Address - Street 1:10154 WOODBURY DR
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9580
Practice Address - Country:US
Practice Address - Phone:724-759-7948
Practice Address - Fax:724-759-7952
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0354061223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
170826OtherUNITED HEALTHCARE
1418485OtherGATEWAY (UNITED CONCORDIA)
PA0019087640002Medicaid
130OtherAVESIS (UPMC FOR YOU)
1083792643OtherAETNA
PA1418485OtherUNITED CONCORDIA