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Individual

DR. DOUGLAS RICHARD MARTIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
1808 W GLEN OAKS LN, MEQUON, WI 53092-2902
(616) 406-9399
Mailing address
1808 W GLEN OAKS LN, MEQUON, WI 53092-2902
(616) 406-9399

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2602-15
WI

Other

Enumeration date
09/02/2009
Last updated
06/26/2012
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