MEDICARE: MICHAEL MARTINSEN DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1346865482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL MARTINSEN DDS, PLLC

Provider Business Mailing Address
First Line	:	12 OLD FORT RD
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-9758
Country	:	US
Telephone Number	:	828-628-3504
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 OLD FORT RD
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-9758
Country	:	US
Telephone Number	:	828-628-3504
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL MARTINSEN
Credential	:	DDS
Telephone Number	:	828-628-3504

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	06/15/2020

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