Provider Demographics
NPI:1649589250
Name:MARTIN, KATAYOON (MPH, DMD)
Entity Type:Individual
Prefix:DR
First Name:KATAYOON
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MPH, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 SUNRISE CROSSING ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2276
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2790 MOSSIDE BLVD
Practice Address - Street 2:140
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2743
Practice Address - Country:US
Practice Address - Phone:412-856-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-113C1223P0221X
PADS0394371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVS6-113COtherSTATE DENTAL LICENSE