Provider Demographics
NPI:1417095233
Name:MARTIN, CARRIE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6332 SHADOW TREE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8243
Mailing Address - Country:US
Mailing Address - Phone:561-649-6606
Mailing Address - Fax:
Practice Address - Street 1:4075 STATE ROAD 7 STE H2
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-8186
Practice Address - Country:US
Practice Address - Phone:561-514-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN169921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice