Provider Demographics
NPI:1760653943
Name:MARTIN, ANTHONY LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:LEWIS
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 1:119 VILLAGE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5643
Mailing Address - Country:US
Mailing Address - Phone:757-886-0300
Mailing Address - Fax:757-886-9747
Practice Address - Street 1:119 VILLAGE AVE STE C
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-5643
Practice Address - Country:US
Practice Address - Phone:757-886-0300
Practice Address - Fax:757-886-9747
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010085991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice