Provider Demographics
NPI:1437253010
Name:MARTIN, WILLIAM GARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GARY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-4850
Mailing Address - Country:US
Mailing Address - Phone:205-428-5093
Mailing Address - Fax:205-428-5594
Practice Address - Street 1:1729 6TH AVE N
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-4850
Practice Address - Country:US
Practice Address - Phone:205-428-5093
Practice Address - Fax:205-428-5594
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist