Provider Demographics
NPI:1316470511
Name:MARTIN, ROY EDWARD JR (DDS)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:EDWARD
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 PHILLIPS AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7370
Mailing Address - Country:US
Mailing Address - Phone:336-889-4733
Mailing Address - Fax:
Practice Address - Street 1:1007 PHILLIPS AVE
Practice Address - Street 2:STE 103
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7370
Practice Address - Country:US
Practice Address - Phone:336-889-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist