Provider Demographics
NPI:1245401926
Name:MARTIN & JACOBSON ORTHODONTICS, INC.
Entity Type:Organization
Organization Name:MARTIN & JACOBSON ORTHODONTICS, INC.
Other - Org Name:PROGRESSIVE ORTHODONTIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LOZANO
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-331-5132
Mailing Address - Street 1:7575 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7600
Mailing Address - Country:US
Mailing Address - Phone:352-331-5132
Mailing Address - Fax:352-332-5472
Practice Address - Street 1:7575 W UNIVERSITY AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-7600
Practice Address - Country:US
Practice Address - Phone:352-331-5132
Practice Address - Fax:352-332-5472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN143291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty