Provider Demographics
NPI:1134226244
Name:MARTIN, RAYMOND WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:WAYNE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CUESTA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3771
Mailing Address - Country:US
Mailing Address - Phone:650-967-2391
Mailing Address - Fax:650-967-1468
Practice Address - Street 1:777 CUESTA DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3771
Practice Address - Country:US
Practice Address - Phone:650-967-2391
Practice Address - Fax:650-967-1468
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist