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General NPI Number Information
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NPI Number | 1992113062
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Entity Type | Individual
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Provider Name | MARTIN SMALLIDGE DMD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 3145 GARDEN AVE
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-7718
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Country | US
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Telephone | 210-808-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 CONNELL RD
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-7664
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Country | US
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Telephone | 210-466-5597
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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 | DS040045
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DS040045
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License Number State | PA
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