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General NPI Number Information
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NPI Number | 1679619118
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Entity Type | Organization
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Legal Business Name | JOHN C. MARTIN D.M.D., M.S.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1728 HIGHWAY 138 SE SUITE 130
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City | CONYERS
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State | GA
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Zip | 30013-5759
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Country | US
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Telephone | 770-761-1330
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Fax | 770-761-1991
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Provider Business Mailing Address
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Address Line | 1728 HIGHWAY 138 SE SUITE 130
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City | CONYERS
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State | GA
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Zip | 30013-5759
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Country | US
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Telephone | 770-761-1330
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Fax | 770-761-1991
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | JOHN C MARTIN
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Credential | D.M.D., M.S.
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Telephone | 770-761-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 008367
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License Number State | GA
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