Provider Demographics
NPI:1609992619
Name:MARTIN, SEAN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST CREEK
Mailing Address - State:NJ
Mailing Address - Zip Code:08092-3123
Mailing Address - Country:US
Mailing Address - Phone:609-597-9290
Mailing Address - Fax:
Practice Address - Street 1:508 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SHIP BOTTOM
Practice Address - State:NJ
Practice Address - Zip Code:08008-4727
Practice Address - Country:US
Practice Address - Phone:609-597-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020921001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice