Provider Demographics
NPI:1275583171
Name:MARTIN, DANETTE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANETTE
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E. CHURCH ST., BOX 278
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8581
Mailing Address - Country:US
Mailing Address - Phone:616-696-9420
Mailing Address - Fax:616-696-8272
Practice Address - Street 1:20 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8581
Practice Address - Country:US
Practice Address - Phone:616-696-9420
Practice Address - Fax:616-696-8272
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice