Provider Demographics
NPI:1417121468
Name:MARTIN TENDER DENTAL LTD
Entity Type:Organization
Organization Name:MARTIN TENDER DENTAL LTD
Other - Org Name:TENDER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-204-8862
Mailing Address - Street 1:5001 E BONANZA RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-3557
Mailing Address - Country:US
Mailing Address - Phone:702-307-2273
Mailing Address - Fax:702-307-2275
Practice Address - Street 1:5001 E BONANZA RD
Practice Address - Street 2:SUITE 160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3557
Practice Address - Country:US
Practice Address - Phone:702-307-2273
Practice Address - Fax:702-307-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty