Provider Demographics
NPI:1609168756
Name:MARTIN, COPELAND AND MARTIN PLLC
Entity Type:Organization
Organization Name:MARTIN, COPELAND AND MARTIN PLLC
Other - Org Name:COMMUNITY DENTAL CARE OF ZILLAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-829-6288
Mailing Address - Street 1:812 ZILLAH WEST RD
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-9542
Mailing Address - Country:US
Mailing Address - Phone:509-829-6288
Mailing Address - Fax:509-314-6603
Practice Address - Street 1:812 ZILLAH WEST RD
Practice Address - Street 2:
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953-9542
Practice Address - Country:US
Practice Address - Phone:509-829-6288
Practice Address - Fax:509-314-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty