Provider Demographics
NPI:1538336615
Name:MARTIN, BRENT D (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3287 AQUINAS DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1212
Mailing Address - Country:US
Mailing Address - Phone:618-401-3727
Mailing Address - Fax:
Practice Address - Street 1:3131 S STATE ST STE 309
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1658
Practice Address - Country:US
Practice Address - Phone:503-906-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190253001223G0001X, 1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223G0001XDental ProvidersDentistGeneral Practice