Individual
DR. ANTHONY CHARLES MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
111 O'BRIAN WAY, IRMO, SC 29063-8776
(803) 749-6072
Mailing address
PO BOX 195, BALLENTINE, SC 29002-0195
(803) 749-6072
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2590
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2590
DENTAL LISENCE
SC
05
—
ZX2590
—
SC
Enumeration date
08/22/2006
Last updated
07/08/2007
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