Provider Demographics
NPI:1619177235
Name:MARTIN, JUSTIN J JR (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:J
Last Name:MARTIN
Suffix:JR
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 1:4117 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9784
Mailing Address - Country:US
Mailing Address - Phone:585-394-8796
Mailing Address - Fax:
Practice Address - Street 1:4117 E LAKE RD
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9784
Practice Address - Country:US
Practice Address - Phone:585-394-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics