Healthcare Provider Details

I. General information

NPI: 1891744819
Provider Name (Legal Business Name): MARTIN SCOTT GOULD DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 MARKET ST
WILMINGTON NC
28411-9728
US

IV. Provider business mailing address

7010 MARKET ST
WILMINGTON NC
28411-9728
US

V. Phone/Fax

Practice location:
  • Phone: 910-686-4644
  • Fax: 910-686-4340
Mailing address:
  • Phone: 910-686-4644
  • Fax: 910-686-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberNC7356
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: