Individual
BRENT ERICKSON MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1721 E LINCOLN AVE, SUNNYSIDE, WA 98944-2478
(509) 837-7178
(509) 837-3117
Mailing address
1721 E LINCOLN AVE, SUNNYSIDE, WA 98944-2478
(509) 837-4022
(509) 839-4022
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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