Provider Demographics
NPI:1447445572
Name:MARTIN, LARRY EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:EDWARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 S PALM CANYON DR STE D7
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6360
Mailing Address - Country:US
Mailing Address - Phone:760-320-2780
Mailing Address - Fax:
Practice Address - Street 1:285 S PALM CANYON DR STE D7
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6360
Practice Address - Country:US
Practice Address - Phone:760-320-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist