Healthcare Provider Details

I. General information

NPI: 1114229614
Provider Name (Legal Business Name): MARTINSVILLE SMILES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 STARLING AVE
MARTINSVILLE VA
24112-3731
US

IV. Provider business mailing address

407 STARLING AVE
MARTINSVILLE VA
24112-3731
US

V. Phone/Fax

Practice location:
  • Phone: 276-632-9266
  • Fax: 276-632-2341
Mailing address:
  • Phone: 276-632-9266
  • Fax: 276-632-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK A CRABTREE
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 276-632-9266