Provider Demographics
NPI:1780813568
Name:MARTIN, ANDREW P (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
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 1:844 SOUTH MARION AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025
Mailing Address - Country:US
Mailing Address - Phone:386-752-8531
Mailing Address - Fax:386-752-7681
Practice Address - Street 1:844 SOUTH MARION AVENUE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-752-8531
Practice Address - Fax:386-752-7681
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist