Organization
M.D.M. OF ELLENTON P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY MARTIN DMD (PRESIDENT)
(941) 254-2300
Entity
Organization
Contact information
Practice address
5975 FACTORY SHOPS BLVD, ELLENTON, FL 34222-4125
(941) 254-2300
Mailing address
701 S HOWARD AVE, STE 106-386, TAMPA, FL 33606-2473
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN18829
FL
Other
Enumeration date
07/30/2014
Last updated
07/30/2014
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