Provider Demographics
NPI:1275875270
Name:MARTIN, TRACY ROBIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ROBIN
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 1:7721 FONTAINE ST
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3304
Mailing Address - Country:US
Mailing Address - Phone:301-983-3077
Mailing Address - Fax:
Practice Address - Street 1:7721 FONTAINE ST
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3304
Practice Address - Country:US
Practice Address - Phone:301-983-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD110841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics