Bryan Barret Martin, D.M.D.
Individual provider Active NPI General Practice Dentistry · Magnolia, MS
NPI 1932300977 · NPPES record last updated Aug 27, 2008
Key facts
- NPI
- 1932300977
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3453-08 (MS)
- Practice address
- 405 N Clark Ave
Magnolia, MS 39652-2609 - Phone
- (601) 783-2606
- Fax
- (601) 783-2617
- NPI assigned
- May 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3453-08 | MS | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bryan B. Martin, DMD, LLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3453-08 | MS | Yes |
Addresses
Primary practice location
405 N Clark Ave
Magnolia, MS 39652-2609
Mailing address
405 N Clark Ave
Magnolia, MS 39652-2609
Phone (601) 783-2606
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07575621 | Medicaid | MS | |
| 1840399-01 | Medicaid | TX |
Other providers in Magnolia, MS
- Angela Francshon Lofton-Varnado
- Monica Roshail Magee
- Magnolia Clinic, Inc.
- Magnolia Family Dental, PLLC
- Magnolia Rehab Company
- Jessica Rene' Mason
- Mississippi State Department of Health
- Lindsey Joan Nobles
- Sharee Nobles
- Rebecca Ann Rayborn
All providers in Magnolia, MS · General Practice Dentistry in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2008. 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.