Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22278 | FL |
NPI | 1003363672 |
---|---|
Provider Name | Jeffrey Martins |
First Address | Lakewood Ranch, FL 34202-2500 |
Second Address | Bradenton, FL 34211-4906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 19/05/2020 |