Provider Demographics
NPI:1063534311
Name:MARTIN, STEVEN JOSEPH (DDS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOSEPH
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 1:1310 PRENTICE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448
Mailing Address - Country:US
Mailing Address - Phone:707-433-5496
Mailing Address - Fax:707-433-5093
Practice Address - Street 1:1310 PRENTICE DR
Practice Address - Street 2:SUITE C
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448
Practice Address - Country:US
Practice Address - Phone:707-433-5496
Practice Address - Fax:707-433-5093
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics