Organization
BRENT J MARTIN DDS MS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT J MARTIN DDS MS SC (ENDODONTIST ORAL AND MAXILLOFACIAL)
(262) 241-3019
Entity
Organization
Contact information
Practice address
1345 W TOWNE SQUARE RD, MEQUON, WI 53092-5047
(262) 241-3019
(262) 241-3027
Mailing address
1345 W TOWNE SQUARE RD, MEQUON, WI 53092-5047
(262) 241-3019
(262) 241-3027
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
2529
WI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2529
WI
Other
Enumeration date
12/15/2006
Last updated
04/24/2012
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