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General NPI Number Information
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NPI Number | 1295901650
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Entity Type | Organization
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Legal Business Name | DR. ERNEST R. MARTIN & DR. EDWINA E. MARTIN D.D.S.
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 215 N SCHOPMEYER ST
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City | GAINESVILLE
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State | TX
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Zip | 76240-4259
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Country | US
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Telephone | 940-665-1742
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Fax | 940-668-8744
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Provider Business Mailing Address
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Address Line | 215 N SCHOPMEYER ST
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City | GAINESVILLE
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State | TX
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Zip | 76240-4259
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Country | US
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Telephone | 940-665-1742
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Fax | 940-668-8744
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. EDWINA E. MARTIN
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Credential | D.D.S.
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Telephone | 940-665-1742
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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 | 18362
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11201
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License Number State | TX
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