Provider Demographics
NPI:1891727590
Name:MARTIN, RONLAD P (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONLAD
Middle Name:P
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 1:125 EAGLES POINTE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6379
Mailing Address - Country:US
Mailing Address - Phone:770-474-0048
Mailing Address - Fax:770-474-0063
Practice Address - Street 1:125 EAGLES POINTE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6379
Practice Address - Country:US
Practice Address - Phone:770-474-0048
Practice Address - Fax:770-474-0063
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA93601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00458202CMedicaid
GA19NCBKPMedicare ID - Type Unspecified
GA00458202CMedicaid