MEDICARE: KALEB MARTIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	D11996	OR

General Provider Information

NPI Number	:	1063268027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALEB MARTIN DDS

Provider Business Mailing Address
First Line	:	13462 PECOS ST
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-1026
Country	:	US
Telephone Number	:	720-252-2046
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 E PINE ST
Second Line	:
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-2811
Country	:	US
Telephone Number	:	541-665-1112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	06/03/2024

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Directions to “ KALEB MARTIN DDS” Practice Location

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