Healthcare Provider Details

I. General information

NPI: 1376799536
Provider Name (Legal Business Name): FRED MRTIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CARPENTER PL
MONROE NY
10950-3516
US

IV. Provider business mailing address

100 CARPENTER PL
MONROE NY
10950-3516
US

V. Phone/Fax

Practice location:
  • Phone: 845-395-0933
  • Fax:
Mailing address:
  • Phone: 845-395-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: