Provider Demographics
NPI:1275527442
Name:MARTINSON, BRUCE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:MARTINSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WAYZATA BLVD E
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1683
Mailing Address - Country:US
Mailing Address - Phone:952-473-4639
Mailing Address - Fax:952-473-1788
Practice Address - Street 1:317 WAYZATA BLVD E
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1683
Practice Address - Country:US
Practice Address - Phone:952-473-4639
Practice Address - Fax:952-473-1788
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND93011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice