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General NPI Number Information
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NPI Number | 1487913299
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Entity Type | Organization
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Legal Business Name | JOHN MARTIN DDS
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 12131 DORSETT ST 211
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043
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Country | US
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Telephone | 314-739-1222
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Fax | 314-739-1094
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Provider Business Mailing Address
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Address Line | 12131 DORSETT ST 211 ST 211
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043
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Country | US
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Telephone | 314-739-1222
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Fax | 314-739-1094
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Authorized Official
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Title or Position | DDS
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Name | DARYL JOHN MARTIN JR.
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Credential | DDS
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Telephone | 314-739-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15178
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License Number State | MO
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