Healthcare Provider Details

I. General information

NPI: 1295203172
Provider Name (Legal Business Name): GREGORY WARREN MARTIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 WISCONSIN AVE STE 1465
CHEVY CHASE MD
20815-6932
US

IV. Provider business mailing address

5454 WISCONSIN AVE STE 1465
CHEVY CHASE MD
20815-6932
US

V. Phone/Fax

Practice location:
  • Phone: 301-652-1039
  • Fax:
Mailing address:
  • Phone: 301-652-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16622
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1001895
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: