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General NPI Number Information
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NPI Number | 1134475445
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Entity Type | Individual
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Provider Name | PATTY LYNN MARTIN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 2014 S HOWARD ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-4532
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Country | US
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Telephone | 509-525-5902
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Fax | 509-525-0832
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Provider Business Mailing Address
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Address Line | 2014 S HOWARD ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-4532
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Country | US
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Telephone | 509-525-5902
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Fax | 509-525-0832
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60291989
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License Number State | WA
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