Individual
CLARK W MARTINEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
(573) 778-4630
Mailing address
3032 SADDLEBROOK TRL, POPLAR BLUFF, MO 63901-1579
(573) 727-9352
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.022745
IL
1223G0001X
General Practice Dentistry
Primary
019.022745
IL
Other
Enumeration date
09/16/2006
Last updated
10/24/2013
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