Healthcare Provider Details

I. General information

NPI: 1861490385
Provider Name (Legal Business Name): SONYA KAYE MARTIN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 W STUART DR
HILLSVILLE VA
24343-1520
US

IV. Provider business mailing address

19255 LANDFALL CT
ABINGDON VA
24210-9694
US

V. Phone/Fax

Practice location:
  • Phone: 276-728-2164
  • Fax: 276-728-2103
Mailing address:
  • Phone: 276-791-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401008239
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: