Provider Demographics
NPI:1477831485
Name:SONYA K. MARTIN DDS LLC
Entity Type:Organization
Organization Name:SONYA K. MARTIN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE STAFF
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-644-1155
Mailing Address - Street 1:2426 LEE HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-5967
Mailing Address - Country:US
Mailing Address - Phone:276-644-1155
Mailing Address - Fax:276-644-1156
Practice Address - Street 1:2426 LEE HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-5967
Practice Address - Country:US
Practice Address - Phone:276-644-1155
Practice Address - Fax:276-644-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010082391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty