Provider Demographics
NPI:1649275298
Name:MARTIN, RISE L (DDS)
Entity type:Individual
Prefix:DR
First Name:RISE
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 FM 1283
Mailing Address - Street 2:STE L
Mailing Address - City:LAKEHILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78063
Mailing Address - Country:US
Mailing Address - Phone:830-612-2626
Mailing Address - Fax:830-612-2628
Practice Address - Street 1:8500 FM 1283
Practice Address - Street 2:STE L
Practice Address - City:LAKEHILLS
Practice Address - State:TX
Practice Address - Zip Code:78063
Practice Address - Country:US
Practice Address - Phone:830-612-2626
Practice Address - Fax:830-612-2628
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-19
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145242701Medicaid
TX1452427-01Medicaid
TXG60017-1OtherDELTA CHIP