Provider Demographics
NPI:1518449776
Name:NATALIE C MARTINEZ-ROGERS DMD PA
Entity Type:Organization
Organization Name:NATALIE C MARTINEZ-ROGERS DMD PA
Other - Org Name:STELLAR DENTAL OF NODA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-688-7120
Mailing Address - Street 1:2100 N DAVIDSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1828
Mailing Address - Country:US
Mailing Address - Phone:704-688-7120
Mailing Address - Fax:704-405-8815
Practice Address - Street 1:2100 N DAVIDSON ST STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205
Practice Address - Country:US
Practice Address - Phone:704-688-7120
Practice Address - Fax:704-405-8815
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-05
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9647122300000X
NC11171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty