Provider Demographics
NPI:1285870931
Name:MARTIN DENTISTRY PC
Entity type:Organization
Organization Name:MARTIN DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-247-8172
Mailing Address - Street 1:1599 FORT HENRY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2535
Mailing Address - Country:US
Mailing Address - Phone:423-247-8172
Mailing Address - Fax:423-392-8253
Practice Address - Street 1:1599 FORT HENRY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2535
Practice Address - Country:US
Practice Address - Phone:423-247-8172
Practice Address - Fax:423-392-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6622390001Medicare NSC