Healthcare Provider Details

I. General information

NPI: 1053235085
Provider Name (Legal Business Name): J MARTIN ANDERSON DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 2ND AVE S STE 103
KENT WA
98032-5873
US

IV. Provider business mailing address

PO BOX 1478
KENT WA
98035-1478
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-5155
  • Fax: 253-852-5159
Mailing address:
  • Phone: 253-852-5155
  • Fax: 253-852-5159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LYNN GABRIEL
Title or Position: REGISTERED AGENT
Credential:
Phone: 253-852-5155