Organization
ANTHONY C. MARTIN DMD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY CHARLES MARTIN DMD (PRESIDENT)
(803) 749-6072
Entity
Organization
Contact information
Practice address
111 OBRIAN 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
261QD0000X
Dental Clinic/Center
Primary
2590
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z2590
—
SC
Enumeration date
12/18/2014
Last updated
12/18/2014
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