Individual
DR. GARY CHADWICK MARTIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5111 LEESBURG PIKE, SKYLINE 5 SUITE 810, FALLS CHURCH, VA 22041-3251
(703) 681-0039
(703) 681-0947
Mailing address
5059 MINDA CT, ALEXANDRIA, VA 22304-7772
(703) 681-0039
(703) 681-0947
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
142116
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1421169921
DENTAL LICENSE
UT
Enumeration date
03/31/2006
Last updated
03/07/2023
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