Provider Demographics
NPI:1508952763
Name:DR RICHARD J MARTIN A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR RICHARD J MARTIN A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-527-8527
Mailing Address - Street 1:1621 BEGLIS PKWY
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5906
Mailing Address - Country:US
Mailing Address - Phone:337-527-8527
Mailing Address - Fax:337-528-2568
Practice Address - Street 1:1621 BEGLIS PKWY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5906
Practice Address - Country:US
Practice Address - Phone:337-527-8527
Practice Address - Fax:337-528-2568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2844261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA172760269OtherAMERICAN DENTAL ASSOC. #