Provider Demographics
NPI:1497748842
Name:MARTIN, BARBARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 LINDBERGH LNDG, BROOKS CLINIC
Mailing Address - Street 2:
Mailing Address - City:BROOKS CITY BASE
Mailing Address - State:TX
Mailing Address - Zip Code:78235-5221
Mailing Address - Country:US
Mailing Address - Phone:210-240-4146
Mailing Address - Fax:
Practice Address - Street 1:8050 LINDBERGH LNDG
Practice Address - Street 2:
Practice Address - City:BROOKS CITY BASE
Practice Address - State:TX
Practice Address - Zip Code:78235-5334
Practice Address - Country:US
Practice Address - Phone:210-240-4146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice