Provider Demographics
NPI:1770874638
Name:MARTIN, DANIEL ANDERSON (DMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDERSON
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 LATHAM LN
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4315
Mailing Address - Country:US
Mailing Address - Phone:916-220-2118
Mailing Address - Fax:916-933-4979
Practice Address - Street 1:4420 TOWN CENTER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7138
Practice Address - Country:US
Practice Address - Phone:916-933-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery