Provider Demographics
NPI:1770594178
Name:JOHN MARTIN DDS PC
Entity type:Organization
Organization Name:JOHN MARTIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-851-9999
Mailing Address - Street 1:2020 CALDWELL ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072
Mailing Address - Country:US
Mailing Address - Phone:615-851-9999
Mailing Address - Fax:615-851-6771
Practice Address - Street 1:2020 CALDWELL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3130
Practice Address - Country:US
Practice Address - Phone:615-851-9999
Practice Address - Fax:615-851-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN84041223G0001X
TN28971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty