Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4429 | SC |
NPI | 1144462698 |
---|---|
Provider Name | Meriana S Martin |
First Address | Beaufort, SC 29902-5570 |
Second Address | Beaufort, SC 29902-5570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2009 |
Last Update Date | 30/03/2009 |