Provider Demographics
NPI:1699929950
Name:MARTIN, JEREMY KYLE (DMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:KYLE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MADRID BLVD
Mailing Address - Street 2:STE 414
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7968
Mailing Address - Country:US
Mailing Address - Phone:941-575-2626
Mailing Address - Fax:
Practice Address - Street 1:100 MADRID BLVD
Practice Address - Street 2:STE 414
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7968
Practice Address - Country:US
Practice Address - Phone:941-575-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist