Healthcare Provider Details

I. General information

NPI: 1295669141
Provider Name (Legal Business Name): MACEY MARTIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DRIVE
GAINESVILLE FL
32610-0001
US

IV. Provider business mailing address

9269 SW 30TH LN
GAINESVILLE FL
32608-7940
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5651
  • Fax:
Mailing address:
  • Phone: 352-226-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: