Individual
JEFF MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
416 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7228
(318) 865-4091
Mailing address
416 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7228
(318) 865-4091
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4720
LA
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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