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Individual
CHARISSA MICHELLE MARTIN
Active
Individual
CHARISSA MICHELLE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2386
MT
1223G0001X
General Practice Dentistry
D8602
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5901637
—
NC
01
—
8098
NC DENTAL LICENSE #
NC
01
—
9022M
BLUE CROSS BLUE SHIELD #
NC
Enumeration date
01/03/2006
Last updated
03/07/2023
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