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Provider Information for 1740303445



DR. JEFFREY TODD MARTIN DDS

Gender: MALE

Individual NPI: 1740303445

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1740303445
Enumeration Date 2007-04-09
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 2700 COLTSGATE RD SUITE 100
CHARLOTTE, NC 28211-3799
United States

Phone: 704-363-4646 | Fax: 704-362-4611
View Map External Link
Primary Practice Address 2700 COLTSGATE RD. STE. #100
CHARLOTTE, NC 28211-3799
United States

Phone: 704-362-4646 | Fax: 704-362-4611
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice NC 5407