Provider Demographics
NPI:1629153762
Name:MARTIN, DAVID JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAY
Last Name:MARTIN
Suffix:
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 1:336 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2554
Mailing Address - Country:US
Mailing Address - Phone:973-942-6467
Mailing Address - Fax:073-942-7763
Practice Address - Street 1:336 UNION BLVD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2554
Practice Address - Country:US
Practice Address - Phone:973-942-6467
Practice Address - Fax:073-942-7763
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist