Individual
JARED MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
115 S MAIN ST, HOMEDALE, ID 83628-3415
(208) 869-2243
Mailing address
15111 KINGS ROW RD, CALDWELL, ID 83607-8371
(208) 869-2243
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4785
ID
1223G0001X
General Practice Dentistry
D-4785
ID
Other
Enumeration date
08/22/2016
Last updated
01/27/2021
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