Provider Demographics
NPI:1720297161
Name:WYMAN B MARTIN DDS PC
Entity Type:Organization
Organization Name:WYMAN B MARTIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WYMAN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-993-7424
Mailing Address - Street 1:45 WEST CROSSVILLE RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075
Mailing Address - Country:US
Mailing Address - Phone:770-993-7424
Mailing Address - Fax:678-461-4436
Practice Address - Street 1:45 WEST CROSSVILLE RD
Practice Address - Street 2:SUITE 505
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075
Practice Address - Country:US
Practice Address - Phone:770-993-7424
Practice Address - Fax:678-461-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty