MEDICARE: DR. ARLENE MARTIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	047169-1	NY
2	122300000X	Dentist	10043	SC
3	1223P0221X	Pediatric Dentistry	10052	SC

General Provider Information

NPI Number	:	1427054717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARLENE MARTIN DDS

Provider Business Mailing Address
First Line	:	721 OKATIE HWY # 170
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-3963
Country	:	US
Telephone Number	:	843-987-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	719 OKATIE HWY # 170
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-3963
Country	:	US
Telephone Number	:	843-987-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/12/2024

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