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General NPI Number Information
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NPI Number | 1609970730
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Entity Type | Individual
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Provider Name | GARY PAUL MARTIN DDS
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Gender | Male
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 605 E 4TH ST
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City | MARSHFIELD
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State | WI
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Zip | 54449-4519
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Country | US
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Telephone | 715-387-6344
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Fax |
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Provider Business Mailing Address
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Address Line | 605 E 4TH ST
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City | MARSHFIELD
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State | WI
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Zip | 54449
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Country | US
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Telephone | 715-387-6344
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Fax | 715-384-2047
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5001476-015
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License Number State | WI
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