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General NPI Number Information
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NPI Number | 1972225068
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Entity Type | Individual
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Provider Name | JEREMY RICHARD MARTENS DMD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 2004 SE 192ND AVE STE 101
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City | VANCOUVER
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State | WA
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Zip | 98683-9526
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Country | US
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Telephone | 360-768-5609
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Fax |
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Provider Business Mailing Address
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Address Line | 19600 NE 3RD ST APT 196
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City | CAMAS
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State | WA
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Zip | 98607-7813
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Country | US
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Telephone | 707-326-9465
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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 | 61322769
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License Number State | WA
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