Healthcare Provider Details

I. General information

NPI: 1760532139
Provider Name (Legal Business Name): MARTY J ESPE DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 W ARROWHEAD RD
DULUTH MN
55811-4046
US

IV. Provider business mailing address

3617 W ARROWHEAD RD
DULUTH MN
55811-4046
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-8377
  • Fax: 218-722-3117
Mailing address:
  • Phone: 218-722-8377
  • Fax: 218-722-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11100
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5006
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number40391
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: