Provider Demographics
NPI:1417160177
Name:DRS. MARTIN AND BRUNE, PLLC
Entity Type:Organization
Organization Name:DRS. MARTIN AND BRUNE, PLLC
Other - Org Name:JASON E. MARTIN, DDS, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRUNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-781-0500
Mailing Address - Street 1:118 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOCUST
Mailing Address - State:NC
Mailing Address - Zip Code:28097
Mailing Address - Country:US
Mailing Address - Phone:704-781-0500
Mailing Address - Fax:704-781-0555
Practice Address - Street 1:118 PROFESSIONAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097
Practice Address - Country:US
Practice Address - Phone:704-781-0500
Practice Address - Fax:704-781-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty