Provider Demographics
NPI:1891964201
Name:MARTIN, GEORGES PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGES
Middle Name:PAUL
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 1:31 S EAGLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3340
Mailing Address - Country:US
Mailing Address - Phone:610-446-9496
Mailing Address - Fax:610-449-0449
Practice Address - Street 1:31 S EAGLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3340
Practice Address - Country:US
Practice Address - Phone:610-446-9496
Practice Address - Fax:610-449-0449
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025838L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice