Provider Demographics
NPI:1306220652
Name:MARTIN, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 CEDARMONT DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4020
Mailing Address - Country:US
Mailing Address - Phone:775-881-8981
Mailing Address - Fax:
Practice Address - Street 1:5111 MARYLAND WAY STE 209
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7513
Practice Address - Country:US
Practice Address - Phone:615-376-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZIN PROCESS122300000X
ORD113031223E0200X
TN127601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty