Provider Demographics
NPI:1659308849
Name:MARTIN, BRIAN STEPHEN (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:STEPHEN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45TH AND PENN AVENUE
Mailing Address - Street 2:7TH FLOOR FACULTY BUILDING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201
Mailing Address - Country:US
Mailing Address - Phone:412-692-6805
Mailing Address - Fax:412-692-7946
Practice Address - Street 1:45TH AND PENN AVENUE
Practice Address - Street 2:3RD FLOOR MAIN HOSPITAL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201
Practice Address - Country:US
Practice Address - Phone:412-692-6805
Practice Address - Fax:412-692-7946
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031029L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017923280001Medicaid
PA123088OtherUNISON HEALTH PLAN
PA920278OtherUNITED CONCORDIA
PA12482OtherDORAL DENTAL