MEDICARE: DR. AMBER TENNILLE MARTIN-BISHOP D.M.D.

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	5562	AL

General Provider Information

NPI Number	:	1558554857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER TENNILLE MARTIN-BISHOP D.M.D.

Provider Business Mailing Address
First Line	:	201 W 8TH ST
Second Line	:	SUITE 810
City	:	PUEBLO
State	:	CO
Zip	:	81003-3038
Country	:	US
Telephone Number	:	719-562-4447
Fax Number	:

Provider Business Practice Location Address
First Line	:	5412 MONTGOMERY HWY
Second Line	:	SUITE 8
City	:	DOTHAN
State	:	AL
Zip	:	36303-1657
Country	:	US
Telephone Number	:	334-983-1730
Fax Number	:

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

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	12/28/2010

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