Provider Demographics
NPI:1184780280
Name:MARTIN, ADAM (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12233 S WINGFOOT CT
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8895
Mailing Address - Country:US
Mailing Address - Phone:801-390-2851
Mailing Address - Fax:
Practice Address - Street 1:4122 QUEST DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-8768
Practice Address - Country:US
Practice Address - Phone:541-359-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD119641223X0400X
UT5911333-89031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics