Provider Demographics
NPI:1942359450
Name:MARTIN, LINDA G (DH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 JACK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-5025
Mailing Address - Country:US
Mailing Address - Phone:251-368-9136
Mailing Address - Fax:251-368-0832
Practice Address - Street 1:5811 JACK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-5025
Practice Address - Country:US
Practice Address - Phone:251-368-9136
Practice Address - Fax:251-368-0832
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3876124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist