Provider Demographics
NPI:1952361008
Name:MARTIN, JOSEPH WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:MARTIN
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 1:1400 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6712
Mailing Address - Country:US
Mailing Address - Phone:541-485-4646
Mailing Address - Fax:541-431-4542
Practice Address - Street 1:1400 EXECUTIVE PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6712
Practice Address - Country:US
Practice Address - Phone:541-485-4646
Practice Address - Fax:541-431-4542
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR57381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice