Provider Demographics
NPI:1114097961
Name:MARTIN, JOHN C (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4011 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2212
Mailing Address - Country:US
Mailing Address - Phone:706-353-1700
Mailing Address - Fax:706-353-1774
Practice Address - Street 1:4011 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2212
Practice Address - Country:US
Practice Address - Phone:706-353-1700
Practice Address - Fax:706-353-1774
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0083671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics