MEDICARE: DR. JEFFREY A MARTIN DMD MS

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	122300000X	Dentist	DN11642	FL

General Provider Information

NPI Number	:	1225131832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY A MARTIN DMD MS

Provider Business Mailing Address
First Line	:	863 OUTER RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6652
Country	:	US
Telephone Number	:	407-898-6711
Fax Number	:	407-895-9982

Provider Business Practice Location Address
First Line	:	863 OUTER RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6652
Country	:	US
Telephone Number	:	407-898-6711
Fax Number	:	407-895-9982

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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