Organization
BRYAN B. MARTIN, DMD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN B MARTIN DMD (DOCTOR/OWNER)
(601) 783-2606
Entity
Organization
Contact information
Practice address
405 N CLARK AVE, MAGNOLIA, MS 39652-2609
(601) 783-2606
(601) 783-0572
Mailing address
405 N CLARK AVE, MAGNOLIA, MS 39652-2609
(601) 783-2606
(601) 783-0572
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
22474
TX
1223G0001X
General Practice Dentistry
Primary
3453.08
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07575621
—
MS
01
—
1932300977
INDIVIDUAL NPI
MS
Enumeration date
04/28/2011
Last updated
04/28/2011
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