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General NPI Number Information
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NPI Number | 1841698149
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Entity Type | Organization
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Legal Business Name | ANTHONY C. MARTIN DMD LLC
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 111 OBRIAN WAY
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City | IRMO
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State | SC
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Zip | 29063-8776
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Country | US
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Telephone | 803-749-6072
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 195
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City | BALLENTINE
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State | SC
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Zip | 29002-0195
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Country | US
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Telephone | 803-749-6072
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY CHARLES MARTIN
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Credential | DMD
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Telephone | 803-749-6072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2590
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License Number State | SC
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