Provider Demographics
NPI:1700805280
Name:MARTIN, LIN R II (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIN
Middle Name:R
Last Name:MARTIN
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LIN
Other - Middle Name:R
Other - Last Name:MARTIN
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:935 S HELENA ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4599
Mailing Address - Country:US
Mailing Address - Phone:909-709-0563
Mailing Address - Fax:
Practice Address - Street 1:1600 E FLORIDA AVE
Practice Address - Street 2:#301
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8643
Practice Address - Country:US
Practice Address - Phone:909-709-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice