Provider Demographics
NPI:1245302397
Name:MARTIN, JEFFERY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:LYNN
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 1:7350 E SPEEDWAY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1366
Mailing Address - Country:US
Mailing Address - Phone:520-747-9024
Mailing Address - Fax:520-747-0148
Practice Address - Street 1:7350 E SPEEDWAY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1366
Practice Address - Country:US
Practice Address - Phone:520-600-6925
Practice Address - Fax:520-747-0148
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD23811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice