Provider Demographics
NPI:1679507081
Name:MARTIN, GARY CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:CHRISTOPHER
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 1:3101 EDWARDS MILL RD STE 109
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5303
Mailing Address - Country:US
Mailing Address - Phone:919-571-0222
Mailing Address - Fax:919-571-0221
Practice Address - Street 1:3101 EDWARDS MILL RD STE 109
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5303
Practice Address - Country:US
Practice Address - Phone:919-571-0222
Practice Address - Fax:919-571-0221
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice