Provider Demographics
NPI:1942642350
Name:JEFFREY L. MARTIN DDS,P.A.
Entity Type:Organization
Organization Name:JEFFREY L. MARTIN DDS,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-223-0575
Mailing Address - Street 1:2700 RICHMOND RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5200
Mailing Address - Country:US
Mailing Address - Phone:903-223-0575
Mailing Address - Fax:903-831-5765
Practice Address - Street 1:2700 RICHMOND RD
Practice Address - Street 2:SUITE 21
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5200
Practice Address - Country:US
Practice Address - Phone:903-223-0575
Practice Address - Fax:903-831-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty