Organization
MARTIN DENTAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAROLD LEE MARIN DDS (OWNER)
(618) 662-2025
Entity
Organization
Contact information
Practice address
501 NORTH MAIN STREET, FLORA, IL 62839
(618) 662-2025
(618) 662-2911
Mailing address
PO BOX 400, FLORA, IL 62839
(618) 662-2025
(618) 662-2911
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101453
—
IL
Enumeration date
01/23/2007
Last updated
08/22/2020
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