Provider Demographics
NPI:1730632647
Name:MARTIN, NICHOLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2603
Mailing Address - Country:US
Mailing Address - Phone:512-731-4841
Mailing Address - Fax:
Practice Address - Street 1:9099 KATY FWY
Practice Address - Street 2:STE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1640
Practice Address - Country:US
Practice Address - Phone:713-465-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice