Provider Demographics
NPI:1558694018
Name:BODDEN, MARTIN K (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:K
Last Name:BODDEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 W. 6TH ST ATTN: NANCY POSEY-CREDENTIALS
Mailing Address - Street 2:BLDG 440, SUITE 18
Mailing Address - City:FT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-4704
Mailing Address - Country:US
Mailing Address - Phone:912-767-6735
Mailing Address - Fax:912-767-5425
Practice Address - Street 1:351 W. 6TH ST ATTN: NANCY POSEY-CREDENTIALS
Practice Address - Street 2:BLDG 440, SUITE 18
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-4704
Practice Address - Country:US
Practice Address - Phone:912-767-6735
Practice Address - Fax:912-767-5425
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL39951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice