Provider Demographics
NPI:1336246461
Name:MARTYN, FAITH ROSALIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FAITH
Middle Name:ROSALIE
Last Name:MARTYN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:FAITH
Other - Middle Name:ROSALIE
Other - Last Name:MCGIBBON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2029 VALLEYGATE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3688
Mailing Address - Country:US
Mailing Address - Phone:910-485-8884
Mailing Address - Fax:910-485-8287
Practice Address - Street 1:2029 VALLEYGATE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3688
Practice Address - Country:US
Practice Address - Phone:910-485-8884
Practice Address - Fax:910-485-8287
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995757Medicaid
NC8995757Medicaid