Provider Demographics
NPI:1427265321
Name:MARTIN, ERNEST RAY (DDS)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:RAY
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 1:215 N SCHOPMEYER ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4259
Mailing Address - Country:US
Mailing Address - Phone:940-665-1742
Mailing Address - Fax:940-668-8744
Practice Address - Street 1:215 N SCHOPMEYER ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4259
Practice Address - Country:US
Practice Address - Phone:940-665-1742
Practice Address - Fax:940-668-8744
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAM7178951OtherDEA REGISTRATION NUMBER