Provider Demographics
NPI:1891808218
Name:MARTIN, ROBERT F JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:MARTIN
Suffix:JR
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 1:137 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL92381OtherBCBSAL
AL009912721Medicaid