Provider Demographics
NPI:1518113125
Name:MARTIN, WILLIAM WALKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALKER
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 1:4935 BOONSBORO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2200
Mailing Address - Country:US
Mailing Address - Phone:434-384-0092
Mailing Address - Fax:434-384-0429
Practice Address - Street 1:4935 BOONSBORO RD
Practice Address - Street 2:SUITE B
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2200
Practice Address - Country:US
Practice Address - Phone:434-384-0092
Practice Address - Fax:434-384-0429
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4010050971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice