Healthcare Provider Details

I. General information

NPI: 1245401926
Provider Name (Legal Business Name): MARTIN & JACOBSON ORTHODONTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 W UNIVERSITY AVE SUITE E
GAINESVILLE FL
32607-7600
US

IV. Provider business mailing address

7575 W UNIVERSITY AVE SUITE E
GAINESVILLE FL
32607-7600
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-5132
  • Fax: 352-332-5472
Mailing address:
  • Phone: 352-331-5132
  • Fax: 352-332-5472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN14329
License Number StateFL

VIII. Authorized Official

Name: DR. DAWN LOZANO MARTIN
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 352-331-5132