Healthcare Provider Details

I. General information

NPI: 1124481627
Provider Name (Legal Business Name): MARTINS DENTAL PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CABOT STREET
BEVERLY MA
01915
US

IV. Provider business mailing address

164 SPRING ST
MEDFORD MA
02155-4068
US

V. Phone/Fax

Practice location:
  • Phone: 978-279-2400
  • Fax:
Mailing address:
  • Phone: 781-866-9126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN21846
License Number StateMA

VIII. Authorized Official

Name: VALERIE MARTINS
Title or Position: PRESIDENT
Credential: DMD
Phone: 781-866-9126