Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 54665 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | S2-103 | NV |
N | 204E00000X | Oral & Maxillofacial Surgeon | 54665 | CA |
NPI | 1215073804 |
---|---|
Provider Name | Dr. Daniel Clayton Martin |
First Address | Truckee, CA 96161-4113 |
Second Address | Truckee, CA 96161-4113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 22/02/2018 |