Provider Demographics
NPI:1518470053
Name:LEE J. MARTIN, DMD, LLC
Entity Type:Organization
Organization Name:LEE J. MARTIN, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-966-2102
Mailing Address - Street 1:109 OGLESBY AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31408-1611
Mailing Address - Country:US
Mailing Address - Phone:912-966-2102
Mailing Address - Fax:912-966-2103
Practice Address - Street 1:109 OGLESBY AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-1611
Practice Address - Country:US
Practice Address - Phone:912-966-2102
Practice Address - Fax:912-966-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014447261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN014447OtherDENTAL LICENSE