MEDICARE: MARTIN AND MARTIN, DDS, PA

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	7463	NC

General Provider Information

NPI Number	:	1891900841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN AND MARTIN, DDS, PA

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	:	OWNER
Name	:	DR. MAJA VUKOJICIC MARTIN
Credential	:	DDS
Telephone Number	:	919-847-0902

Provider Enumeration Date	:	05/12/2007
Last Update Date	:	08/22/2020

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