Individual
DR. INDIA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1520 S MAIN ST, BLACKWELL, OK 74631-4921
(580) 262-8420
Mailing address
1520 S MAIN ST, BLACKWELL, OK 74631-4921
(580) 262-8420
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7959
OK
1223G0001X
General Practice Dentistry
0401418605
VA
Other
Enumeration date
08/08/2023
Last updated
10/18/2024
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