Provider Demographics
NPI:1629788773
Name:MARTIN ORTHODONTICS, PA
Entity Type:Organization
Organization Name:MARTIN ORTHODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-371-3200
Mailing Address - Street 1:13820 W NEWBERRY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3700
Mailing Address - Country:US
Mailing Address - Phone:352-371-3200
Mailing Address - Fax:
Practice Address - Street 1:13820 W NEWBERRY RD STE 300
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32669-3700
Practice Address - Country:US
Practice Address - Phone:352-371-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty