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General NPI Number Information
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NPI Number | 1588700900
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Entity Type | Organization
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Legal Business Name | DRS. LARSON, MARTYN, & HAFNER, LLP
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 10562 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53092-5537
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Country | US
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Telephone | 262-240-1220
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Fax | 262-240-1232
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Provider Business Mailing Address
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Address Line | 10562 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53092-5537
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Country | US
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Telephone | 262-240-1220
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Fax | 262-240-1232
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Authorized Official
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Title or Position | DENTIST PARTNER
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Name | DR. DAVID G. MARTYN
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Credential | D. D. S.
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Telephone | 262-240-0554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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