Provider Demographics
NPI:1497812036
Name:MARTIN, DANA RAY
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:RAY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 KINGSTON PIKE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3319
Mailing Address - Country:US
Mailing Address - Phone:865-470-2995
Mailing Address - Fax:865-470-2213
Practice Address - Street 1:9950 KINGSTON PIKE
Practice Address - Street 2:SUITE 210
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3319
Practice Address - Country:US
Practice Address - Phone:865-470-2995
Practice Address - Fax:865-470-2213
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000070781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics