Healthcare Provider Details

I. General information

NPI: 1609322569
Provider Name (Legal Business Name): RODNEY MARTIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 11TH AVE NE
HICKORY NC
28601-3835
US

IV. Provider business mailing address

245 11TH AVE NE
HICKORY NC
28601-3835
US

V. Phone/Fax

Practice location:
  • Phone: 828-414-2802
  • Fax:
Mailing address:
  • Phone: 828-414-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401418741
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN05164
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number14536
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: