Provider Demographics
NPI:1649318965
Name:MARTIN, ALBERT EDWARD JR (DDS)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:EDWARD
Last Name:MARTIN
Suffix:JR
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 1:1440 WASHINGTON BLVD
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-4098
Mailing Address - Country:US
Mailing Address - Phone:925-672-7997
Mailing Address - Fax:925-672-5376
Practice Address - Street 1:1440 WASHINGTON BLVD
Practice Address - Street 2:SUITE B-3
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-4098
Practice Address - Country:US
Practice Address - Phone:925-672-7997
Practice Address - Fax:925-672-5376
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL250741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice