Provider Demographics
NPI:1700869641
Name:MARTIN, RAYMOND KIRK (DDS,MAGD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:KIRK
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS,MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CHAUNCY ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1200
Mailing Address - Country:US
Mailing Address - Phone:508-337-8555
Mailing Address - Fax:508-337-6862
Practice Address - Street 1:200 CHAUNCY ST
Practice Address - Street 2:SUITE 212
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1200
Practice Address - Country:US
Practice Address - Phone:508-337-8555
Practice Address - Fax:508-337-6862
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice