Provider Demographics
NPI:1144462698
Name:MARTIN, MERIANA S (DMD)
Entity type:Individual
Prefix:
First Name:MERIANA
Middle Name:S
Last Name:MARTIN
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 1:1002 BAY ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5570
Mailing Address - Country:US
Mailing Address - Phone:843-525-6264
Mailing Address - Fax:843-522-8967
Practice Address - Street 1:1002 BAY ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5570
Practice Address - Country:US
Practice Address - Phone:843-525-6264
Practice Address - Fax:843-522-8967
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics