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General NPI Number Information
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NPI Number | 1710134960
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Entity Type | Organization
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Legal Business Name | CRAIG T. MARTINSON
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 1102 N COLUMBIA AVE
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City | RINCON
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State | GA
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Zip | 31326-6807
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Country | US
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Telephone | 912-564-7107
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Fax | 912-826-2432
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Provider Business Mailing Address
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Address Line | 1102 N COLUMBIA AVE
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City | RINCON
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State | GA
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Zip | 31326-6807
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Country | US
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Telephone | 912-564-7107
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Fax | 912-826-2432
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Authorized Official
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Title or Position | CEO
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Name | DR. CRAIG T. MARTINSON
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Credential |
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Telephone | 912-564-7107
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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 | DN011197
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License Number State | GA
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