Provider Demographics
NPI:1730132465
Name:MARTIN, BRIAN PRESTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PRESTON
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 1:1 FREEDOM WAY
Mailing Address - Street 2:BUILDING 110-RM-2A-196
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6258
Mailing Address - Country:US
Mailing Address - Phone:706-830-7609
Mailing Address - Fax:706-481-6721
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:BUILDING 110-RM-2A-196
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-830-7609
Practice Address - Fax:706-481-6721
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4053225X00000X
GADN014599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA303475451AMedicaid