Provider Demographics
NPI:1619986320
Name:MARTINSON, MARIA H (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:H
Last Name:MARTINSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-2229
Mailing Address - Country:US
Mailing Address - Phone:912-564-2263
Mailing Address - Fax:
Practice Address - Street 1:112 CLIFFORD AVE
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-2012
Practice Address - Country:US
Practice Address - Phone:912-564-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00590543AMedicaid