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General NPI Number Information
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NPI Number | 1417058843
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Entity Type | Organization
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Legal Business Name | DRS HARE AND MARTIN PA
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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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
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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 ST
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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 | 864-882-2372
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THEODORE H MARTIN
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Credential | DMD
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Telephone | 864-882-2372
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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 | 1383
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License Number State | SC
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Taxonomy #2
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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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