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Organization
DRS HARE AND MARTIN PA
Active
Organization
DRS HARE AND MARTIN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE H MARTIN DMD (DENTIST)
(864) 882-2372
Entity
Organization
Contact information
Practice address
208 N WALNUT ST, SENECA, SC 29678
(864) 882-2372
(864) 886-0063
Mailing address
PO BOX 815, 208 N WALNUT ST, SENECA, SC 29679-0815
(864) 882-2372
(864) 882-2372
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1383
SC
1223G0001X
General Practice Dentistry
Primary
3661
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55321
DENTAL BENEFIT PROVIDERS
—
01
—
88007179
BLUECROSSBLUESHIELD
AL
01
—
88018195
BLUECROSSBLUESHIELD
AL
01
—
Z13833
MEDICAID
SC
01
—
Z97805
BLUECROSSBLUESHIELD
MA
01
—
ZX3661
MEDICAID
SC
Enumeration date
09/26/2006
Last updated
08/22/2020
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