Healthcare Provider Details

I. General information

NPI: 1043149099
Provider Name (Legal Business Name): RACHEL MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11904 SYCAMORE TRCE
PLAIN CITY OH
43064-4403
US

IV. Provider business mailing address

11904 SYCAMORE TRCE
PLAIN CITY OH
43064-4403
US

V. Phone/Fax

Practice location:
  • Phone: 614-245-2751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028010
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: