Provider Demographics
NPI:1215502554
Name:MARTIN DENTISTRY PC
Entity type:Organization
Organization Name:MARTIN DENTISTRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-543-6444
Mailing Address - Street 1:407 HUDSON DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2888
Mailing Address - Country:US
Mailing Address - Phone:423-543-6444
Mailing Address - Fax:
Practice Address - Street 1:407 HUDSON DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2888
Practice Address - Country:US
Practice Address - Phone:423-543-6444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTIN DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-20
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty