Provider Demographics
NPI:1336794155
Name:MARTIN, VANESSA MARIE (DDS)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:MARIE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1507 GOVERNOR RITCHIE HIGHWAY
Mailing Address - Street 2:#201
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012
Mailing Address - Country:US
Mailing Address - Phone:410-757-5437
Mailing Address - Fax:
Practice Address - Street 1:1507 GOVENRNOR RITCHIE HWY STE 201
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2744
Practice Address - Country:US
Practice Address - Phone:410-757-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry