Provider Demographics
NPI:1407840887
Name:MARTIN, JEAN ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ALLEN
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 1:150 NE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3712
Mailing Address - Country:US
Mailing Address - Phone:503-266-2629
Mailing Address - Fax:503-266-2625
Practice Address - Street 1:150 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3712
Practice Address - Country:US
Practice Address - Phone:503-266-2629
Practice Address - Fax:503-266-2625
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice