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General NPI Number Information
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NPI Number | 1841208733
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Entity Type | Individual
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Provider Name | ELMER GARNEL MARTIN DMD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 1001 S SEASIDE AVE # BLDGE23
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City | SAN PEDRO
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State | CA
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Zip | 90731
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Country | US
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Telephone | 310-521-6071
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 102
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City | SAN PEDRO
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State | CA
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Zip | 90733-0102
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Country | US
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Telephone | 510-437-3616
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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 | 41473
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License Number State | CA
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