=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689896326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT B MARTIN D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 05/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1970 UNIVERSITY AVE
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92507-5202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-213-3450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 PARK AVE
-----------------------------------------------------
City | SOMERVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-2318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-526-1600
-----------------------------------------------------
Fax | 908-526-9140
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 10770
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------