Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12863 | TX |
NPI | 1023172905 |
---|---|
Provider Name | Steven Dale Martin |
First Address | San Antonio, TX 78250-6804 |
Second Address | San Antonio, TX 78250-6804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |