Provider Demographics
NPI:1386752855
Name:SHEDECK, MARTIN J (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:SHEDECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7517 CAMERON ROAD SUITE 107
Mailing Address - Street 2:LONGHORN DENTAL
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752
Mailing Address - Country:US
Mailing Address - Phone:512-371-1222
Mailing Address - Fax:512-371-3914
Practice Address - Street 1:950 UNIVERSITY DR #101
Practice Address - Street 2:LONGHORN DENTAL
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626
Practice Address - Country:US
Practice Address - Phone:512-930-5930
Practice Address - Fax:512-869-0276
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX22728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist