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General NPI Number Information
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NPI Number | 1083792634
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Entity Type | Individual
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Provider Name | JEFFREY WILLIAM MARTZ DMD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 04/26/2015
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Provider Practice Location Address
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Address Line | 10154 WOODBURY DR
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City | WEXFORD
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State | PA
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Zip | 15090-9580
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Country | US
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Telephone | 724-759-7948
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Fax | 724-759-7952
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Provider Business Mailing Address
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Address Line | 118 BITTERSWEET CIR
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City | VENETIA
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State | PA
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Zip | 15367-1000
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Country | US
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Telephone | 412-996-0889
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Fax | 724-260-0044
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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 | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | DS035406
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License Number State | PA
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