Provider Demographics
NPI:1417068859
Name:MARTIN, JO ANN
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 CARLON LOOP RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-9674
Mailing Address - Country:US
Mailing Address - Phone:360-425-0534
Mailing Address - Fax:
Practice Address - Street 1:292 CARLON LOOP RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-9674
Practice Address - Country:US
Practice Address - Phone:360-425-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant