Provider Demographics
NPI:1205967155
Name:DEVER, MARTHA GERDSEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:GERDSEN
Last Name:DEVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:ELLEN
Other - Last Name:GERDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9144 CINCINNATI-COLUMBUS ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-777-6444
Mailing Address - Fax:
Practice Address - Street 1:9144 CINCINNATI-COLUMBUS ROAD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-777-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2501122300000X
OH30-0224011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist