Basic Information
| Provider Information | |||||||||
| NPI: | 1558694018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BODDEN | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 351 W. 6TH ST ATTN: NANCY POSEY-CREDENTIALS | ||||||||
| Address2: | BLDG 440, SUITE 18 | ||||||||
| City: | FT STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313144704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127676735 | ||||||||
| FaxNumber: | 9127675425 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 W. 6TH ST ATTN: NANCY POSEY-CREDENTIALS | ||||||||
| Address2: | BLDG 440, SUITE 18 | ||||||||
| City: | FT STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313144704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127676735 | ||||||||
| FaxNumber: | 9127675425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2009 | ||||||||
| LastUpdateDate: | 09/15/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 3995 | AL | Y | Dental Providers | Dentist | General Practice |
No ID Information.