Provider Demographics
NPI:1871152041
Name:MARTIN, VELVET ENJOLI (DMD)
Entity type:Individual
Prefix:DR
First Name:VELVET
Middle Name:ENJOLI
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 1:111 GARWIN DR W APT 2B
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2769
Mailing Address - Country:US
Mailing Address - Phone:252-443-7764
Mailing Address - Fax:
Practice Address - Street 1:8282 NC 58 S
Practice Address - Street 2:
Practice Address - City:ELM CITY
Practice Address - State:NC
Practice Address - Zip Code:27822-8079
Practice Address - Country:US
Practice Address - Phone:252-443-7764
Practice Address - Fax:252-443-7611
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice