MEDICARE: DR. JURGA D MARTINI DMD, PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00008704	WA

General Provider Information

NPI Number	:	1073682449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JURGA D MARTINI DMD, PS

Provider Business Mailing Address
First Line	:	1220 HOWELL ST
Second Line	:	SUITE 110
City	:	SEATTLE
State	:	WA
Zip	:	98101-1469
Country	:	US
Telephone Number	:	206-464-9002
Fax Number	:	206-464-9003

Provider Business Practice Location Address
First Line	:	1220 HOWELL ST
Second Line	:	SUITE 110
City	:	SEATTLE
State	:	WA
Zip	:	98101-1469
Country	:	US
Telephone Number	:	206-464-9002
Fax Number	:	206-464-9003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	05/21/2015

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