Provider Demographics
NPI:1568485993
Name:MICHAEL E MARTIN DDS PC
Entity Type:Organization
Organization Name:MICHAEL E MARTIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-856-5022
Mailing Address - Street 1:3227 DEAN RD
Mailing Address - Street 2:P.O. BOX 66
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9614
Mailing Address - Country:US
Mailing Address - Phone:734-856-5022
Mailing Address - Fax:734-856-1022
Practice Address - Street 1:3227 DEAN RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9614
Practice Address - Country:US
Practice Address - Phone:734-856-5022
Practice Address - Fax:734-856-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010146351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty