Provider Demographics
NPI:1598884108
Name:BRYAN D. MARTZ D.D.S., M.S., INC.
Entity Type:Organization
Organization Name:BRYAN D. MARTZ D.D.S., M.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-756-8888
Mailing Address - Street 1:625 CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1038
Mailing Address - Country:US
Mailing Address - Phone:419-756-8888
Mailing Address - Fax:419-756-4547
Practice Address - Street 1:625 CLINE AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1038
Practice Address - Country:US
Practice Address - Phone:419-756-8888
Practice Address - Fax:419-756-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-46951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty