MEDICARE: DR. EDWARD JAMES 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	122300000X	Dentist	12006965	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578526208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD JAMES MARTIN DDS

Provider Business Mailing Address
First Line	:	1302 PEARL ST
Second Line	:
City	:	COVINGTON
State	:	IN
Zip	:	47932
Country	:	US
Telephone Number	:	765-793-4680
Fax Number	:	765-793-0513

Provider Business Practice Location Address
First Line	:	1302 PEARL ST
Second Line	:
City	:	COVINGTON
State	:	IN
Zip	:	47932
Country	:	US
Telephone Number	:	765-793-4680
Fax Number	:	765-793-0513

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	07/08/2007

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