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General NPI Number Information
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NPI Number | 1225188931
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Entity Type | Individual
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Provider Name | THEODORE H MARTIN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 208 N WALNUT ST
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City | SENECA
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State | SC
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Zip | 29678-2724
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Country | US
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Telephone | 864-882-2372
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Fax | 864-886-0063
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Provider Business Mailing Address
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Address Line | PO BOX 815 208 N. WALNUT STREET
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City | SENECA
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State | SC
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Zip | 29679-0815
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Country | US
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Telephone | 864-882-2372
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Fax | 864-886-0063
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3661
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License Number State | SC
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