Provider Demographics
NPI:1114064086
Name:JOHN C. MARTIN D.M.D., M.S.
Entity Type:Organization
Organization Name:JOHN C. MARTIN D.M.D., M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:678-963-9888
Mailing Address - Street 1:17 MONROE HWY
Mailing Address - Street 2:SUITE CC & DD
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-7186
Mailing Address - Country:US
Mailing Address - Phone:678-963-9888
Mailing Address - Fax:678-963-9871
Practice Address - Street 1:17 MONROE HWY
Practice Address - Street 2:SUITE CC & DD
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-7186
Practice Address - Country:US
Practice Address - Phone:678-963-9888
Practice Address - Fax:678-963-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0083671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty