Healthcare Provider Details

I. General information

NPI: 1346205218
Provider Name (Legal Business Name): JOEL O'HARA MARTIN BS, DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BERGEN ST ROOM D-843
NEWARK NJ
07103-2495
US

IV. Provider business mailing address

110 BERGEN STREET PO BOX 1709
NEWARK NJ
07101-1709
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-3367
  • Fax: 973-972-0370
Mailing address:
  • Phone: 973-972-3367
  • Fax: 973-972-0370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number22DI01270300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: