Provider Demographics
NPI:1497153142
Name:NATHAN S. MARTIN, DDS, LLC
Entity Type:Organization
Organization Name:NATHAN S. MARTIN, DDS, LLC
Other - Org Name:NORTHSIDE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-519-6978
Mailing Address - Street 1:7933 WINDHILL DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1820
Mailing Address - Country:US
Mailing Address - Phone:317-519-6978
Mailing Address - Fax:
Practice Address - Street 1:625 E BRISTOL ST STE A
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3476
Practice Address - Country:US
Practice Address - Phone:317-519-6978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012108A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty