Individual
JACK W. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
11726
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111134601
—
TX
01
—
800349
BCBS
TX
Enumeration date
10/03/2006
Last updated
11/09/2010
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