Provider Demographics
NPI:1912015447
Name:DAVID H MARTIN PSC
Entity Type:Organization
Organization Name:DAVID H MARTIN PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-525-1420
Mailing Address - Street 1:7208 DIXIE HIGHWAY
Mailing Address - Street 2:PO BOX 395
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41022-0395
Mailing Address - Country:US
Mailing Address - Phone:859-525-1420
Mailing Address - Fax:859-525-0948
Practice Address - Street 1:7208 DIXIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41022-0395
Practice Address - Country:US
Practice Address - Phone:859-525-1420
Practice Address - Fax:859-525-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty