Provider Demographics
NPI:1366007601
Name:MARTIN, CHRISTINA ANNA (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANNA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 W ADMIRAL DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1764
Mailing Address - Country:US
Mailing Address - Phone:937-620-5713
Mailing Address - Fax:
Practice Address - Street 1:1432 N GREAT NECK RD STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1342
Practice Address - Country:US
Practice Address - Phone:757-486-7857
Practice Address - Fax:757-486-4441
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X390200000X
VA04014169201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program