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Individual
BRENT ERICKSON MARTIN
Active
Individual
BRENT ERICKSON MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE60029611
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5057039
—
WA
01
—
DE60029611
WASHINGTON STATE DENTAL LICENSE
WA
Enumeration date
06/30/2008
Last updated
05/08/2012
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