Organization
DOUGLAS R. MARTIN DDS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS RICHARD MARTIN D.D.S. (SOLE MEMBER)
(616) 406-9399
Entity
Organization
Contact information
Practice address
2905 S 12TH ST, SHEBOYGAN, WI 53081-6705
(616) 406-9399
Mailing address
1808 W GLEN OAKS LN, MEQUON, WI 53092-2902
(616) 406-9399
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2602-15
WI
Other
Enumeration date
09/16/2009
Last updated
10/30/2012
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