Organization
FORT THEATRE DENTISTRY
Active
Organization
FORT THEATRE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER D MARTIN DMD (OWNER)
(308) 237-5853
Entity
Organization
Contact information
Practice address
2205 CENTRAL AVE, KEARNEY, NE 68847-5346
(308) 237-5853
(308) 237-5089
Mailing address
2205 CENTRAL AVE, KEARNEY, NE 68847-5346
(308) 237-5853
(308) 237-5089
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100252764-00
—
NE
Enumeration date
05/21/2007
Last updated
09/11/2025
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