Provider Demographics
NPI:1346205218
Name:MARTIN, JOEL O'HARA (BS, DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:O'HARA
Last Name:MARTIN
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Gender:M
Credentials:BS, DDS, MS
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Mailing Address - Street 1:110 BERGEN STREET
Mailing Address - Street 2:PO BOX 1709
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-1709
Mailing Address - Country:US
Mailing Address - Phone:973-972-3367
Mailing Address - Fax:973-972-0370
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:ROOM D-843
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-3367
Practice Address - Fax:973-972-0370
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ22DI012703001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics