=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427055219
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTEN N LADMAN D.M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 87 COUNTY ROAD 520
-----------------------------------------------------
City | MORGANVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07751-1241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-972-0002
-----------------------------------------------------
Fax | 732-972-5636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 87 COUNTY ROAD 520
-----------------------------------------------------
City | MORGANVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07751-1241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-972-0002
-----------------------------------------------------
Fax | 732-972-5636
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | NJDI 14939
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------