Healthcare Provider Details

I. General information

NPI: 1073445003
Provider Name (Legal Business Name): GREGORY JAMES MARTENS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 PEARSON DR
HUDSON WI
54016-8727
US

IV. Provider business mailing address

4202 W 42ND ST
EDINA MN
55416-5008
US

V. Phone/Fax

Practice location:
  • Phone: 715-377-9966
  • Fax: 715-377-9933
Mailing address:
  • Phone: 952-928-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number600220215
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: