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Individual
JACK W. MARTIN
Active
Individual
JACK W. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
11726
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111134601
—
TX
01
—
800349
BCBS
TX
Enumeration date
10/03/2006
Last updated
11/09/2010
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