Provider Demographics
NPI:1871745307
Name:MARTIN, PHILLIP SIDNEY (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:SIDNEY
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 1:15511 ANNAPOLIS RD STE 540
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3014
Mailing Address - Country:US
Mailing Address - Phone:301-200-8484
Mailing Address - Fax:
Practice Address - Street 1:15511 ANNAPOLIS RD STE 540
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3014
Practice Address - Country:US
Practice Address - Phone:301-200-8484
Practice Address - Fax:301-200-8484
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000762122300000X
MD14280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist