Provider Demographics
NPI:1750786570
Name:NATALIE C MARTINEZ-ROGERS DMD PA
Entity type:Organization
Organization Name:NATALIE C MARTINEZ-ROGERS DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:MARTINEZ-ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-547-1199
Mailing Address - Street 1:9010 GLENWATER DRIVE
Mailing Address - Street 2:#104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-547-1199
Mailing Address - Fax:704-549-4699
Practice Address - Street 1:9010 GLENWATER DRIVE
Practice Address - Street 2:#104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-547-1199
Practice Address - Fax:704-549-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111711223G0001X
NC9547124Q00000X
NC96571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty