Individual
DR. MITISHA NICHOLE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
5316 S. 3RD STREET, LOUISVILLE, KY 40214
(502) 276-8778
Mailing address
5316 S. 3RD STREET, LOUISVILLE, KY 40214
(502) 276-8778
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8651
KY
Other
Enumeration date
06/23/2008
Last updated
07/14/2020
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