Individual
CHARISSA MICHELLE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
211 NORTH MAIN STREET, BOULDER, MT 59631
(406) 225-4222
(406) 225-4222
Mailing address
211 NORTH MAIN STREET, PO BOX 512, BOULDER, MT 59631
(406) 225-4222
(406) 225-4222
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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