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General NPI Number Information
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NPI Number | 1144585290
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Entity Type | Individual
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Provider Name | WALTER MARTIN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 2225 E W T HARRIS BLVD STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28213-5384
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Country | US
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Telephone | 704-494-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 7903 WILBY HOLLOW DR
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City | CHARLOTTE
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State | NC
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Zip | 28270-1824
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Country | US
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Telephone | 336-407-7224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9670
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License Number State | NC
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