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CRAIG T. MARTINSON D.M.D.
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1679582399
Individual Registrant: CRAIG T. MARTINSON D.M.D.
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
112 CLIFFORD AVE SYLVANIA, GA 30467-2012 US
Tel: 912-564-7107 Fax: --
Tel: 912-564-7107 Fax: --
Contact information for business:
611 S MAIN ST SYLVANIA, GA 30467-2229 US
Tel: 912-564-2263 Fax: --
Tel: 912-564-2263 Fax: --
Registration Information:
NPI: 1679582399
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | GA | 11197 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 00577332B | GA | 05 | |
| TAX IDENTIFICATION NUMBER | 581269769 | GA | 01 |
