Individual
DR. THEODORE H MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
208 N WALNUT ST, SENECA, SC 29678-2724
(864) 882-2372
(864) 886-0063
Mailing address
PO BOX 815, 208 N. WALNUT STREET, SENECA, SC 29679-0815
(864) 882-2372
(864) 886-0063
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3661
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5532-1
DENTAL BENEFIT PROVIDERS
—
01
—
803157
DELTA DENTAL OF PA
—
01
—
Z97805
BCBS OF MA
—
05
—
ZX3661
—
SC
Enumeration date
01/12/2007
Last updated
07/09/2007
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