Provider Demographics
NPI:1346250941
Name:MARTIN, SIDNEY SOLOMON (DDS)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:SOLOMON
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 1:4141 NW 5TH STREET
Mailing Address - Street 2:#102
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:954-791-1220
Mailing Address - Fax:
Practice Address - Street 1:4141 NW 5TH STREET
Practice Address - Street 2:#102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-791-1220
Practice Address - Fax:954-791-0631
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist