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General NPI Number Information
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NPI Number | 1922790369
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Entity Type | Individual
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Provider Name | AMANDA DANIELLE MARTIN DDS
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Gender | Female
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 4184 PEARL RD STE 103
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City | MEDINA
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State | OH
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Zip | 44256-6641
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Country | US
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Telephone | 330-236-0677
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Fax |
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Provider Business Mailing Address
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Address Line | 2196 REIMER RD
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City | WADSWORTH
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State | OH
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Zip | 44281-8441
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Country | US
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Telephone | 330-388-7707
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.027123
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License Number State | OH
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