Healthcare Provider Details

I. General information

NPI: 1184780280
Provider Name (Legal Business Name): ADAM MARTIN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 QUEST DR
EUGENE OR
97402-8768
US

IV. Provider business mailing address

12233 S WINGFOOT CT
DRAPER UT
84020-8895
US

V. Phone/Fax

Practice location:
  • Phone: 541-359-3261
  • Fax:
Mailing address:
  • Phone: 801-390-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD11964
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5911333-8903
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: