Provider Demographics
NPI:1891744819
Name:GOULD, MARTIN SCOTT (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:SCOTT
Last Name:GOULD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9728
Mailing Address - Country:US
Mailing Address - Phone:910-686-4644
Mailing Address - Fax:910-686-4340
Practice Address - Street 1:7010 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9728
Practice Address - Country:US
Practice Address - Phone:910-686-4644
Practice Address - Fax:910-686-4340
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC73561223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics