Healthcare Provider Details

I. General information

NPI: 1487004537
Provider Name (Legal Business Name): BRENDA LEE MARTIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 S BROADWAY STE 300
LORAIN OH
44053-3871
US

IV. Provider business mailing address

6100 S BROADWAY STE 300
LORAIN OH
44053-3871
US

V. Phone/Fax

Practice location:
  • Phone: 440-233-8521
  • Fax:
Mailing address:
  • Phone: 440-233-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: