Provider Demographics
NPI:1376711093
Name:MARTIN, DAVID JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
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 1:938 DEWING AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4271
Mailing Address - Country:US
Mailing Address - Phone:925-283-6564
Mailing Address - Fax:925-283-0827
Practice Address - Street 1:938 DEWING AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4271
Practice Address - Country:US
Practice Address - Phone:925-283-6564
Practice Address - Fax:925-283-0827
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice