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General NPI Number Information
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NPI Number | 1154819043
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Entity Type | Individual
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Provider Name | DR. ALAN J MARTIN
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Gender | Male
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 268 HERBERT ST
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-4000
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Country | US
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Telephone | 904-829-1962
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Fax |
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Provider Business Mailing Address
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Address Line | 690 WILD CYPRESS CIR
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32081-5731
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Country | US
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Telephone | 904-829-1962
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Fax | 904-395-3489
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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 | DN23010
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License Number State | FL
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