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NPI Code Detail

MEDICARE: MARTIN TENDER DENTAL LTD

MEDICARE: MARTIN TENDER DENTAL LTD
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
11223S0112XOral and Maxillofacial Surgery (Dentist)S2-26NV

General Provider Information

NPI Number : 1417121468
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARTIN TENDER DENTAL LTD
Provider Business Mailing Address
First Line : 5001 E BONANZA RD
Second Line : SUITE 160
City : LAS VEGAS
State : NV
Zip : 89110-3557
Country : US
Telephone Number : 702-307-2273
Fax Number : 702-307-2275
Provider Business Practice Location Address
First Line : 5001 E BONANZA RD
Second Line : SUITE 160
City : LAS VEGAS
State : NV
Zip : 89110-3557
Country : US
Telephone Number : 702-307-2273
Fax Number : 702-307-2275
Authorized Official
Title or Position : OWNER
Name : DR. KEVIN M MARTIN
Credential : DDS
Telephone Number : 702-204-8862
Provider Enumeration Date : 04/21/2008
Last Update Date : 04/21/2008

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Directions to “MARTIN TENDER DENTAL LTD ” Practice Location

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