Provider Demographics
NPI:1619041944
Name:PROCTOR, MARTHA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 N MICHIGAN AVE
Mailing Address - Street 2:STE. 921-E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2252
Mailing Address - Country:US
Mailing Address - Phone:312-751-0026
Mailing Address - Fax:312-751-0241
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:STE. 921-E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-751-0026
Practice Address - Fax:312-751-0241
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics