Provider Demographics
NPI:1992934665
Name:RAYMOND K MARTIN DDS MAGD PC INC.
Entity type:Organization
Organization Name:RAYMOND K MARTIN DDS MAGD PC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-337-8555
Mailing Address - Street 1:200 CHAUNCY ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048
Mailing Address - Country:US
Mailing Address - Phone:508-337-8555
Mailing Address - Fax:508-337-6862
Practice Address - Street 1:200 CHAUNCY ST
Practice Address - Street 2:SUITE 212
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048
Practice Address - Country:US
Practice Address - Phone:508-337-8555
Practice Address - Fax:508-337-6862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty