Provider Demographics
NPI:1154211951
Name:MARTIN, TREVOR (DMD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12922 MARYSVILLE LN
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7532
Mailing Address - Country:US
Mailing Address - Phone:503-975-6606
Mailing Address - Fax:503-975-6606
Practice Address - Street 1:17680 SW HANDLEY ST STE 101
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9255
Practice Address - Country:US
Practice Address - Phone:503-822-0245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD122141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice