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NPI Code Detail

MEDICARE: RICHARD EARL MARTZKE DDS

MEDICARE:   RICHARD EARL MARTZKE  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2901010346MI

General Provider Information

NPI Number : 1508904004
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD EARL MARTZKE DDS
Provider Business Mailing Address
First Line : 311 HARRISON ST
Second Line :
City : GRAND LEDGE
State : MI
Zip : 48837-1532
Country : US
Telephone Number : 517-627-2422
Fax Number : 517-627-7549
Provider Business Practice Location Address
First Line : 311 HARRISON ST
Second Line :
City : GRAND LEDGE
State : MI
Zip : 48837-1532
Country : US
Telephone Number : 517-627-2422
Fax Number : 517-627-7549
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 07/08/2007

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Directions to “ RICHARD EARL MARTZKE DDS” Practice Location

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