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General NPI Number Information
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NPI Number | 1184749822
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Entity Type | Organization
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Legal Business Name | JUSTIN D MARTIN DDS PC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1200 FIRST COLONIAL ROAD SUITE 201
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454
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Country | US
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Telephone | 757-333-3399
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Fax | 757-333-4946
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Provider Business Mailing Address
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Address Line | 1200 FIRST COLONIAL ROAD SUITE 201
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454
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Country | US
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Telephone | 757-333-3399
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Fax | 757-333-4946
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUSTIN DAVID MARTIN
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Credential | DDS
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Telephone | 757-333-3399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 0401008614
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License Number State | VA
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