Individual
MR. GERALD THOMAS MARTIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2012 N MAIN ST, SHELBYVILLE, TN 37160-2022
(931) 684-6351
Mailing address
2012 N MAIN ST, SHELBYVILLE, TN 37160-2022
(931) 684-6351
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1880
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016359
TNCARE PROVIDER NUMBER
TN
Enumeration date
10/31/2005
Last updated
07/08/2007
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