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General NPI Number Information
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NPI Number | 1447335682
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Entity Type | Individual
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Provider Name | ERIC ANTON MARTIN DDS
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 895 MORAGA RD STE 6
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City | LAFAYETTE
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State | CA
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Zip | 94549-5039
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Country | US
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Telephone | 925-283-8101
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Fax | 925-283-9372
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Provider Business Mailing Address
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Address Line | 895 MORAGA RD STE 6
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City | LAFAYETTE
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State | CA
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Zip | 94549-5039
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Country | US
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Telephone | 925-283-8101
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Fax | 925-283-9372
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 51617
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License Number State | CA
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