MEDICARE: PIERRE MARTIN 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	4554	AZ

General Provider Information

NPI Number	:	1427144328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIERRE MARTIN DDS

Provider Business Mailing Address
First Line	:	3773 W INA RD
Second Line	:	#180
City	:	TUCSON
State	:	AZ
Zip	:	85741-2246
Country	:	US
Telephone Number	:	520-579-8166
Fax Number	:	520-579-8167

Provider Business Practice Location Address
First Line	:	3773 W INA RD
Second Line	:	#180
City	:	TUCSON
State	:	AZ
Zip	:	85741-2246
Country	:	US
Telephone Number	:	520-579-8166
Fax Number	:	520-579-8167

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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Directions to “ PIERRE MARTIN DDS” Practice Location

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