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General NPI Number Information
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NPI Number | 1053668830
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Entity Type | Individual
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Provider Name | LEE JOSHUA MARTIN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2012
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 402 N VETERANS BLVD
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City | GLENNVILLE
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State | GA
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Zip | 30427-2054
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Country | US
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Telephone | 912-654-1519
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Fax |
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Provider Business Mailing Address
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Address Line | 154 BRIANNA CIR
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City | SAVANNAH
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State | GA
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Zip | 31419-8148
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Country | US
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Telephone | 912-659-9643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN014447
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License Number State | GA
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