Provider Demographics
NPI:1780955047
Name:MARTIN, FERMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:FERMIN
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 1:2475 PASEO DE LAS AMERICAS STE 1781
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-7255
Mailing Address - Country:US
Mailing Address - Phone:619-600-5183
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA AEROPUERTO #1900
Practice Address - Street 2:LOCAL E-21
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA NORTE
Practice Address - Zip Code:22457
Practice Address - Country:MX
Practice Address - Phone:664-647-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ4118736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist