Provider Demographics
NPI:1497862924
Name:MARTIN, WILLIAM ROBERT JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:MARTIN
Suffix:JR
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 1:851 SHANKS DR.
Mailing Address - Street 2:P. O. BOX 42
Mailing Address - City:MAPLESVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36750-0042
Mailing Address - Country:US
Mailing Address - Phone:334-366-4295
Mailing Address - Fax:334-366-2005
Practice Address - Street 1:851 SHANKS DR.
Practice Address - Street 2:
Practice Address - City:MAPLESVILLE
Practice Address - State:AL
Practice Address - Zip Code:36750-0042
Practice Address - Country:US
Practice Address - Phone:334-366-4295
Practice Address - Fax:334-366-2005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice