Provider Demographics
NPI:1821149501
Name:ROBERT F MARTIN JR DMD PC
Entity Type:Organization
Organization Name:ROBERT F MARTIN JR DMD PC
Other - Org Name:ROBERT F MARTIN JR DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-382-9610
Mailing Address - Street 1:137 INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3731
Mailing Address - Country:US
Mailing Address - Phone:334-382-9610
Mailing Address - Fax:334-382-2930
Practice Address - Street 1:137 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3731
Practice Address - Country:US
Practice Address - Phone:334-382-9610
Practice Address - Fax:334-382-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0008405450Medicaid
AL92381OtherBCBSAL