Healthcare Provider Details

I. General information

NPI: 1588820799
Provider Name (Legal Business Name): THOMAS ANTHONY MARTIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 LITTLE YORK CIR
EDGEMOOR SC
29712-7806
US

IV. Provider business mailing address

1751 LITTLE YORK CIR
EDGEMOOR SC
29712-7806
US

V. Phone/Fax

Practice location:
  • Phone: 716-908-6733
  • Fax:
Mailing address:
  • Phone: 716-908-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11001
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: