MEDICARE: DR. DAVID W MARTIN D.M.D

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	1223G0001X	General Practice Dentistry	17134	MA

General Provider Information

NPI Number	:	1245251719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID W MARTIN D.M.D

Provider Business Mailing Address
First Line	:	7 MULHOLLAND DR
Second Line	:
City	:	IPSWICH
State	:	MA
Zip	:	01938-2822
Country	:	US
Telephone Number	:	978-356-4408
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 PARK ST
Second Line	:
City	:	NORTH READING
State	:	MA
Zip	:	01864-2375
Country	:	US
Telephone Number	:	978-664-2081
Fax Number	:	978-664-2859

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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