Provider Demographics
NPI:1588914543
Name:WOOLSEY, MARTIN MCCLAIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:MCCLAIN
Last Name:WOOLSEY
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 1:719 BAYSHORE DR
Mailing Address - Street 2:EMERALD COAST PERIODONTICS
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2527
Mailing Address - Country:US
Mailing Address - Phone:850-678-6485
Mailing Address - Fax:850-678-5245
Practice Address - Street 1:719 BAYSHORE DR
Practice Address - Street 2:EMERALD COAST PERIODONTICS
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2527
Practice Address - Country:US
Practice Address - Phone:850-678-6485
Practice Address - Fax:850-678-5245
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012018306122300000X
FLDN210041223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist