Provider Demographics
NPI:1689081002
Name:MARTIN, PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
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 1:1643 6TH AVE
Mailing Address - Street 2:#413
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2757
Mailing Address - Country:US
Mailing Address - Phone:509-845-6510
Mailing Address - Fax:
Practice Address - Street 1:6990 EL CAMINO REAL
Practice Address - Street 2:SUITE O
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4112
Practice Address - Country:US
Practice Address - Phone:760-438-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist