Provider Demographics
NPI:1184714339
Name:MARTIN, STEVEN DOUGLAS (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1495 ALPHARETTA HWY
Mailing Address - Street 2:SUITE J
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-2077
Mailing Address - Country:US
Mailing Address - Phone:770-664-1342
Mailing Address - Fax:770-664-1359
Practice Address - Street 1:1495 ALPHARETTA HWY
Practice Address - Street 2:SUITE J
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-2077
Practice Address - Country:US
Practice Address - Phone:770-664-1342
Practice Address - Fax:770-664-1359
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice