Provider Demographics
NPI:1447358361
Name:MARTIN, RONALD M (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
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 1:517 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1364
Mailing Address - Country:US
Mailing Address - Phone:610-777-7646
Mailing Address - Fax:610-777-7570
Practice Address - Street 1:517 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1364
Practice Address - Country:US
Practice Address - Phone:610-777-7646
Practice Address - Fax:610-777-7570
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019158-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005247250001Medicaid
PA18604OtherHEALTH AM/HEALTH ASSURANC
PA50004505OtherCAPITAL BLUE CROSS
PA99919158OtherDELTA DENTAL OF PA
PA0005247250002Medicaid
PAMA035691OtherHIGHMARK BLUE SHIELD
PA50004505OtherCAPITAL BLUE CROSS
PAT27245Medicare UPIN