Provider Demographics
NPI:1134475445
Name:MARTIN, PATTY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATTY
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 S HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4532
Mailing Address - Country:US
Mailing Address - Phone:509-525-5902
Mailing Address - Fax:509-525-0832
Practice Address - Street 1:2014 S HOWARD ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4532
Practice Address - Country:US
Practice Address - Phone:509-525-5902
Practice Address - Fax:509-525-0832
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60291989122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist