Provider Demographics
NPI:1215094925
Name:HERBERT G MARTIN DDS INC
Entity type:Organization
Organization Name:HERBERT G MARTIN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-833-4439
Mailing Address - Street 1:1360 W 6TH ST
Mailing Address - Street 2:#110
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732
Mailing Address - Country:US
Mailing Address - Phone:310-833-4439
Mailing Address - Fax:310-833-4999
Practice Address - Street 1:1360 W 6TH ST
Practice Address - Street 2:#110
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732
Practice Address - Country:US
Practice Address - Phone:310-833-4439
Practice Address - Fax:310-833-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAL13684122300000X
CA13684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty