Provider Demographics
NPI:1598748436
Name:MARTIN, JOSHUA (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MARTIN
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 1:845 N 100 W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3180
Mailing Address - Country:US
Mailing Address - Phone:520-955-7759
Mailing Address - Fax:801-227-7887
Practice Address - Street 1:845 N 100 W
Practice Address - Street 2:SUITE 100
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3180
Practice Address - Country:US
Practice Address - Phone:520-955-7759
Practice Address - Fax:801-227-7887
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ792029Medicaid