Individual
MR. VERNON ARTHUR MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.D.
Contact information
Practice address
10102 NE GLISAN ST, PORTLAND, OR 97220-4456
(503) 257-5959
Mailing address
21506 NE LACHENVIEW LN, FAIRVIEW, OR 97024-9737
(503) 667-8053
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
0516028598
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0516028598
LICENSED DENTURIST
OR
Enumeration date
08/01/2006
Last updated
07/08/2007
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