MEDICARE: DR. GARY CHRISTOPHER MARTIN DDS

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	1223G0001X	General Practice Dentistry	6587	NC

General Provider Information

NPI Number	:	1679507081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY CHRISTOPHER MARTIN DDS

Provider Business Mailing Address
First Line	:	3101 EDWARDS MILL RD STE 109
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5303
Country	:	US
Telephone Number	:	919-571-0222
Fax Number	:	919-571-0221

Provider Business Practice Location Address
First Line	:	3101 EDWARDS MILL RD STE 109
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5303
Country	:	US
Telephone Number	:	919-571-0222
Fax Number	:	919-571-0221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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