Provider Demographics
NPI:1962761411
Name:MARTINS, MOSHOOD B (MS)
Entity type:Individual
Prefix:
First Name:MOSHOOD
Middle Name:B
Last Name:MARTINS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:MOSHOOD
Other - Middle Name:B
Other - Last Name:MARTINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:7040 PEACH STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509
Mailing Address - Country:US
Mailing Address - Phone:814-866-7500
Mailing Address - Fax:814-866-7555
Practice Address - Street 1:7040 PEACH STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509
Practice Address - Country:US
Practice Address - Phone:814-866-7500
Practice Address - Fax:814-866-7555
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0243401223X0400X
PADS0389781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics