Provider Demographics
NPI:1225286677
Name:MARTIN, MATTHEW JOSHUA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOSHUA
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:106 N COTTONWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4736
Mailing Address - Country:US
Mailing Address - Phone:972-783-8811
Mailing Address - Fax:972-680-1024
Practice Address - Street 1:106 N COTTONWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4736
Practice Address - Country:US
Practice Address - Phone:972-783-8811
Practice Address - Fax:972-680-1024
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022864122300000X
TX260491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist