Provider Demographics
NPI:1194539577
Name:DR BRENT MARTIN DMD PLLC
Entity type:Organization
Organization Name:DR BRENT MARTIN DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-314-6600
Mailing Address - Street 1:812 ZILLAH WEST RD
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-9542
Mailing Address - Country:US
Mailing Address - Phone:509-314-6600
Mailing Address - Fax:844-314-6603
Practice Address - Street 1:812 ZILLAH WEST RD
Practice Address - Street 2:
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953-9542
Practice Address - Country:US
Practice Address - Phone:509-314-6600
Practice Address - Fax:844-314-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentist
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment