MEDICARE: ANDREW MARTINSSEN DDS

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	6788	AZ

General Provider Information

NPI Number	:	1235225012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW MARTINSSEN DDS

Provider Business Mailing Address
First Line	:	6565 E CARONDELET DR
Second Line	:	SUITE 355
City	:	TUCSON
State	:	AZ
Zip	:	85710-2157
Country	:	US
Telephone Number	:	520-733-9224
Fax Number	:	520-722-0538

Provider Business Practice Location Address
First Line	:	6565 E CARONDELET DR
Second Line	:	SUITE 355
City	:	TUCSON
State	:	AZ
Zip	:	85710-2157
Country	:	US
Telephone Number	:	520-733-9224
Fax Number	:	520-722-0538

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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