Healthcare Provider Details

I. General information

NPI: 1649589250
Provider Name (Legal Business Name): KATAYOON MARTIN MPH, DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 MOSSIDE BLVD 140
MONROEVILLE PA
15146-2743
US

IV. Provider business mailing address

787 SUNRISE CROSSING ST
HENDERSON NV
89014-2276
US

V. Phone/Fax

Practice location:
  • Phone: 412-856-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-113C
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS039437
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierS6-113C
Identifier TypeOTHER
Identifier StateNV
Identifier IssuerSTATE DENTAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: