Healthcare Provider Details

I. General information

NPI: 1619433976
Provider Name (Legal Business Name): JEFFREY W MARTZ DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10154 WOODBURY DR
WEXFORD PA
15090-9580
US

IV. Provider business mailing address

354 BUCKINGHAM DR
VENETIA PA
15367-2382
US

V. Phone/Fax

Practice location:
  • Phone: 412-609-6979
  • Fax:
Mailing address:
  • Phone: 412-996-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY MARTZ
Title or Position: OWNER-ANESTHESIOLOGIST
Credential: DMD
Phone: 412-996-0889