Provider Demographics
NPI:1215073804
Name:MARTIN, DANIEL CLAYTON (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CLAYTON
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 1:40165 TRUCKEE AIRPORT RD
Mailing Address - Street 2:STE 303
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4113
Mailing Address - Country:US
Mailing Address - Phone:530-587-5440
Mailing Address - Fax:
Practice Address - Street 1:40165 TRUCKEE AIRPORT RD
Practice Address - Street 2:STE 303
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4113
Practice Address - Country:US
Practice Address - Phone:530-587-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-1031223S0112X
CA54665204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery