Provider Demographics
NPI:1295901650
Name:DR. ERNEST R. MARTIN & DR. EDWINA E. MARTIN D.D.S.
Entity type:Organization
Organization Name:DR. ERNEST R. MARTIN & DR. EDWINA E. MARTIN D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-665-1742
Mailing Address - Street 1:215 N SCHOPMEYER ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4259
Mailing Address - Country:US
Mailing Address - Phone:940-665-1742
Mailing Address - Fax:940-668-8744
Practice Address - Street 1:215 N SCHOPMEYER ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4259
Practice Address - Country:US
Practice Address - Phone:940-665-1742
Practice Address - Fax:940-668-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183621223G0001X
TX112011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty