Provider Demographics
NPI:1235116419
Name:MARTIN, J CHRIS (DMD)
Entity type:Individual
Prefix:DR
First Name:J
Middle Name:CHRIS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4311
Mailing Address - Country:US
Mailing Address - Phone:503-585-8420
Mailing Address - Fax:503-581-3879
Practice Address - Street 1:1625 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4311
Practice Address - Country:US
Practice Address - Phone:503-585-8420
Practice Address - Fax:503-581-3879
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR47471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry