Provider Demographics
NPI:1194833772
Name:KRIEGER, MARTIN P (DDS)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:P
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MARTIN
Other - Middle Name:PHILIP
Other - Last Name:KRIEGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:810 CANTON RD
Mailing Address - Street 2:STE D
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060
Mailing Address - Country:US
Mailing Address - Phone:770-422-8264
Mailing Address - Fax:770-422-4051
Practice Address - Street 1:810 CANTON RD
Practice Address - Street 2:STE D
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-422-8264
Practice Address - Fax:770-422-4051
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000066943AMedicaid