Provider Demographics
NPI:1356360051
Name:MARTIN, MICHAEL KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KIM
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MUNDY
Other - Middle Name:MILL
Other - Last Name:DENTAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4328 MUNDY MILL RD
Mailing Address - Street 2:PO BOX 329
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2518
Mailing Address - Country:US
Mailing Address - Phone:770-534-3350
Mailing Address - Fax:
Practice Address - Street 1:4328 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2518
Practice Address - Country:US
Practice Address - Phone:770-534-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0095731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice