Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 15183 | OH |
NPI | 1003969742 |
---|---|
Provider Name | Dr. Robert Douglas Martin |
First Address | Washington C H, OH 43160 |
Second Address | Washington C H, OH 43160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |