Provider Demographics
NPI:1366507063
Name:ST. MARTIN, MARIE WILENNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:WILENNE
Last Name:ST. 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 1:1554 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1001
Mailing Address - Country:US
Mailing Address - Phone:410-674-7360
Mailing Address - Fax:410-674-5422
Practice Address - Street 1:1554 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1001
Practice Address - Country:US
Practice Address - Phone:410-674-7360
Practice Address - Fax:410-674-5422
Is Sole Proprietor?:No
Enumeration Date:2006-12-25
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist