=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376644765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID J. MARTIN, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 336 UNION BLVD
-----------------------------------------------------
City | TOTOWA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07512-2554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-942-6467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 336 UNION BLVD
-----------------------------------------------------
City | TOTOWA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07512-2554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-942-6467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER/DENTIST
-----------------------------------------------------
Name | DR. DEBRA M. FERRAIOLO
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 973-942-6467
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 06310
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------