Provider Demographics
NPI:1043335292
Name:MARTIN, JANET ELAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:ELAINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:ELAINE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3740 E LAKE CTR
Mailing Address - Street 2:SUITE B
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5805
Mailing Address - Country:US
Mailing Address - Phone:217-214-4545
Mailing Address - Fax:217-214-4546
Practice Address - Street 1:3740 E LAKE CTR
Practice Address - Street 2:SUITE B
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5805
Practice Address - Country:US
Practice Address - Phone:217-214-4545
Practice Address - Fax:217-214-4546
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19161751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice