MEDICARE: DR. ERIC ANTON 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	1223P0300X	Periodontics	51617	CA

General Provider Information

NPI Number	:	1447335682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC ANTON MARTIN DDS

Provider Business Mailing Address
First Line	:	895 MORAGA RD STE 6
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-5039
Country	:	US
Telephone Number	:	925-283-8101
Fax Number	:	925-283-9372

Provider Business Practice Location Address
First Line	:	895 MORAGA RD STE 6
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-5039
Country	:	US
Telephone Number	:	925-283-8101
Fax Number	:	925-283-9372

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	10/01/2018

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