Organization
JEFFREY LEE MARTIN, DMD A PROFESSIONAL DENTAL CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY LEE MARTIN DMD (OWNER)
(318) 865-4091
Entity
Organization
Contact information
Practice address
416 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7228
(318) 865-4091
Mailing address
416 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7228
(318) 865-4091
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5297
LA
Other
Enumeration date
02/02/2007
Last updated
08/22/2020
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