Individual
DR. BLAKE AUSTIN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8310 STATE AVE, KANSAS CITY, KS 66112-1841
(913) 334-5225
Mailing address
22157 207TH ST, TONGANOXIE, KS 66086-4139
(913) 485-9878
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
61913
KS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2022
Last updated
06/15/2022
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