M.D.M. of Ellenton P.a.
Organization Active NPI Dentist · Ellenton, FL
NPI 1558779918 · NPPES record last updated Jul 30, 2014
Key facts
- NPI
- 1558779918
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- DN18829 (FL)
- Legal business name
- M.D.M. OF ELLENTON P.A.
- Practice address
- 5975 Factory Shops Blvd
Ellenton, FL 34222-4125 - Phone
- (941) 254-2300
- NPI assigned
- Jul 30, 2014
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeffrey Martin, DMD
- Title
- President
- Phone
- (941) 254-2300
National Provider Directory
Locations
701 S Howard Ave
Ste 106386
Tampa, FL 33606
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | DN18829 | FL | Yes |
Addresses
Primary practice location
5975 Factory Shops Blvd
Ellenton, FL 34222-4125
Mailing address
701 S Howard Ave
Ste 106-386
Tampa, FL 33606-2473
Other providers in Ellenton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.