Individual
DR. BRYAN BARRET MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
405 N CLARK AVE, MAGNOLIA, MS 39652-2609
(601) 783-2606
(601) 783-2617
Mailing address
405 N CLARK AVE, MAGNOLIA, MS 39652-2609
(601) 783-2606
(601) 783-2617
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3453-08
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07575621
—
MS
05
—
1840399-01
—
TX
Enumeration date
05/29/2007
Last updated
08/27/2008
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