Provider Demographics
NPI:1164649489
Name:MARTIN, LAYNE B (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAYNE
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 MADISON AVE FL 19
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1009
Mailing Address - Country:US
Mailing Address - Phone:297-226-8309
Mailing Address - Fax:
Practice Address - Street 1:10 FOREST AVE STE 105
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5238
Practice Address - Country:US
Practice Address - Phone:347-242-5585
Practice Address - Fax:833-939-0189
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0480811223G0001X
NJ22DI021714001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice