Provider Demographics
NPI:1033221775
Name:O'HARA, MARTHA JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:JANE
Last Name:O'HARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:JANE
Other - Last Name:MCNABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:922 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-7420
Mailing Address - Country:US
Mailing Address - Phone:910-346-1133
Mailing Address - Fax:
Practice Address - Street 1:922 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-7420
Practice Address - Country:US
Practice Address - Phone:910-346-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899006VMedicaid