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General NPI Number Information
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NPI Number | 1942642350
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Entity Type | Organization
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Legal Business Name | JEFFREY L. MARTIN DDS,P.A.
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Dates
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Enumeration Date | 07/26/2013
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Last Update Date | 07/26/2013
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Provider Practice Location Address
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Address Line | 2700 RICHMOND RD SUITE 21
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City | TEXARKANA
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State | TX
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Zip | 75503-5200
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Country | US
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Telephone | 903-223-0575
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Fax | 903-831-5765
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Provider Business Mailing Address
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Address Line | 2700 RICHMOND RD SUITE 21
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City | TEXARKANA
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State | TX
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Zip | 75503-5200
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Country | US
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Telephone | 903-223-0575
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Fax | 903-831-5765
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. JEFFREY L MARTIN
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Credential | DDS
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Telephone | 903-223-0575
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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 | 27810
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License Number State | TX
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