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Organization
WALTER GENTRY MARTIN DDS PLLC
Active
Organization
WALTER GENTRY MARTIN DDS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER GENTRY MARTIN SR. DDS (ADMINISTRATOR)
(336) 407-7224
Entity
Organization
Contact information
Practice address
2225 E W T HARRIS BLVD STE 100, CHARLOTTE, NC 28213-5384
(704) 494-4050
Mailing address
7903 WILBY HOLLOW DR, CHARLOTTE, NC 28270-1824
(336) 407-7224
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144585290
—
NC
Enumeration date
09/23/2020
Last updated
09/23/2020
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