Provider Demographics
NPI:1376251744
Name:THOMAS MARTIN DDS PLLC
Entity Type:Organization
Organization Name:THOMAS MARTIN DDS PLLC
Other - Org Name:MARTIN DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-431-8208
Mailing Address - Street 1:505 MYATT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2451
Mailing Address - Country:US
Mailing Address - Phone:615-865-2260
Mailing Address - Fax:
Practice Address - Street 1:505 MYATT DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2451
Practice Address - Country:US
Practice Address - Phone:615-865-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty