Provider Demographics
NPI:1962563239
Name:MARTIN, TU-WANDA MARABLE
Entity type:Individual
Prefix:
First Name:TU-WANDA
Middle Name:MARABLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3111
Mailing Address - Country:US
Mailing Address - Phone:719-583-1800
Mailing Address - Fax:
Practice Address - Street 1:225 S PLEASANTBURG DR
Practice Address - Street 2:E10
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2544
Practice Address - Country:US
Practice Address - Phone:864-233-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry