Provider Demographics
NPI:1295203172
Name:MARTIN, GREGORY WARREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WARREN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 WISCONSIN AVE STE 1465
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6932
Mailing Address - Country:US
Mailing Address - Phone:301-652-1039
Mailing Address - Fax:
Practice Address - Street 1:5454 WISCONSIN AVE STE 1465
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6932
Practice Address - Country:US
Practice Address - Phone:301-652-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD166221223G0001X
DC1001895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist