Provider Demographics
NPI:1245251719
Name:MARTIN, DAVID W (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MULHOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2822
Mailing Address - Country:US
Mailing Address - Phone:978-356-4408
Mailing Address - Fax:
Practice Address - Street 1:180 PARK ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2375
Practice Address - Country:US
Practice Address - Phone:978-664-2081
Practice Address - Fax:978-664-2859
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice