Provider Demographics
NPI:1831507631
Name:MARTIN, BRETT LEWIS (DMD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:LEWIS
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 1:21152 E RITTENHOUSE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4964
Mailing Address - Country:US
Mailing Address - Phone:480-650-9929
Mailing Address - Fax:
Practice Address - Street 1:21152 E RITTENHOUSE RD STE 106
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4964
Practice Address - Country:US
Practice Address - Phone:480-650-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0097571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice