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General NPI Number Information
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NPI Number | 1659555811
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Entity Type | Individual
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Provider Name | MARK MARTINDALE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 10/12/2025
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Provider Practice Location Address
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Address Line | 1528 LUCKY ST
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City | GRIFFIN
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State | GA
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Zip | 30223-1176
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Country | US
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Telephone | 770-637-5876
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Fax | 770-228-5564
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Provider Business Mailing Address
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Address Line | PO BOX 104
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City | EXPERIMENT
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State | GA
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Zip | 30212-0104
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Country | US
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Telephone | 954-554-4746
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN17886
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN014482
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License Number State | GA
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