MEDICARE: DR. JEFFERY LYNN MARTIN D.D.S.

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	D2381	AZ

General Provider Information

NPI Number	:	1245302397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY LYNN MARTIN D.D.S.

Provider Business Mailing Address
First Line	:	7350 E SPEEDWAY BLVD STE 201
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1366
Country	:	US
Telephone Number	:	520-747-9024
Fax Number	:	520-747-0148

Provider Business Practice Location Address
First Line	:	7350 E SPEEDWAY BLVD STE 201
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1366
Country	:	US
Telephone Number	:	520-600-6925
Fax Number	:	520-747-0148

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	01/12/2022

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