Provider Demographics
NPI:1881002053
Name:ROBERT S. MARTIN, D.M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT S. MARTIN, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-721-3403
Mailing Address - Street 1:2410 EVERGREEN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1848
Mailing Address - Country:US
Mailing Address - Phone:410-721-3403
Mailing Address - Fax:
Practice Address - Street 1:2410 EVERGREEN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1848
Practice Address - Country:US
Practice Address - Phone:410-721-3403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD54011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty