Healthcare Provider Details

I. General information

NPI: 1730061441
Provider Name (Legal Business Name): JUSTIN TOWNSEND MARTIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 S COLUMBIA ST
CHAPEL HILL NC
27514-4309
US

IV. Provider business mailing address

79 TARWICK AVE
CHAPEL HILL NC
27516-4149
US

V. Phone/Fax

Practice location:
  • Phone: 919-537-3737
  • Fax:
Mailing address:
  • Phone: 630-328-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDDS-10244
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: