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General NPI Number Information
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NPI Number | 1689750457
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Entity Type | Organization
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Legal Business Name | DANA J MARTIN DDS PC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 AIRLINE ROAD
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City | PAULS VALLEY
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State | OK
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Zip | 73075
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Country | US
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Telephone | 405-238-2222
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Fax | 405-238-5181
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Provider Business Mailing Address
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Address Line | 1600 AIRLINE ROAD
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City | PAULS VALLEY
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State | OK
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Zip | 73075
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Country | US
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Telephone | 405-238-2222
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Fax | 405-238-5181
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DANA J MARTIN
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Credential | DDS
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Telephone | 405-238-2222
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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 | 5200
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License Number State | OK
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