MEDICARE: KIMBERLY MARTIN DMD

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	DD2317	NM

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	:	1649263039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MARTIN DMD

Provider Business Mailing Address
First Line	:	705 E UNIVERSITY AVE
Second Line	:	STE B
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5637
Country	:	US
Telephone Number	:	505-521-0127
Fax Number	:	505-647-9533

Provider Business Practice Location Address
First Line	:	705 E UNIVERSITY AVE
Second Line	:	STE B
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5637
Country	:	US
Telephone Number	:	505-521-0127
Fax Number	:	505-647-9533

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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Directions to “ KIMBERLY MARTIN DMD” Practice Location

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