Provider Demographics
NPI:1558370056
Name:JACKMAN, MARTIN B (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:B
Last Name:JACKMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501B NUT TREE CT
Mailing Address - Street 2:
Mailing Address - City:YACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687
Mailing Address - Country:US
Mailing Address - Phone:707-451-2982
Mailing Address - Fax:707-451-0391
Practice Address - Street 1:501B NUT TREE CT
Practice Address - Street 2:
Practice Address - City:YACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-451-2982
Practice Address - Fax:707-451-0391
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist