Provider Demographics
NPI:1548422959
Name:MARTIN, BOYD DWAIN III (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:BOYD
Middle Name:DWAIN
Last Name:MARTIN
Suffix:III
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 POINT DEL MAR
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1552
Mailing Address - Country:US
Mailing Address - Phone:949-720-3751
Mailing Address - Fax:
Practice Address - Street 1:140 HIDDEN VALLEY PKWY
Practice Address - Street 2:SUITE K
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-4000
Practice Address - Country:US
Practice Address - Phone:951-898-8673
Practice Address - Fax:951-898-1147
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics