# SHANNON M MARTIN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386839918
- **Authorized official:** SHANNON M MARTIN DDS (DENTIST)
- **Authorized official phone:** (757) 930-9100

## Contact information

- **Practice address:** 12650 WARWICK BLVD, NEWPORT NEWS, VA 23606
- **Practice address phone:** (757) 930-9100
- **Practice address fax:** (757) 930-8900
- **Mailing address:** 12650 WARWICK BLVD, NEWPORT NEWS, VA 23606
- **Mailing address phone:** (757) 930-9100
- **Mailing address fax:** (757) 930-8900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | VA7853 | VA | Yes |

## Other

- **Enumeration date:** 09/06/2007
- **Last updated:** 09/06/2007