Provider Demographics
NPI:1811079874
Name:MARTINA, BRIAN A (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:MARTINA
Suffix:
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 1:722 AVENUE D
Mailing Address - Street 2:SUITE 15
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2365
Mailing Address - Country:US
Mailing Address - Phone:360-568-0766
Mailing Address - Fax:
Practice Address - Street 1:722 AVENUE D
Practice Address - Street 2:SUITE 15
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2365
Practice Address - Country:US
Practice Address - Phone:360-568-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000059461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice