Provider Demographics
NPI:1720160237
Name:SCOTTY, MARTHA SHELDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:SHELDON
Last Name:SCOTTY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 BARN SWALLOW DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-1281
Mailing Address - Country:US
Mailing Address - Phone:757-673-2132
Mailing Address - Fax:
Practice Address - Street 1:4912 BARN SWALLOW DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-1281
Practice Address - Country:US
Practice Address - Phone:757-673-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD75221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery