Provider Demographics
NPI:1639661895
Name:SPELTER, MARTINA (DDS)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:SPELTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:
Other - Last Name:SIEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2040 SIEKER LN
Mailing Address - Street 2:
Mailing Address - City:GREENLEAF
Mailing Address - State:WI
Mailing Address - Zip Code:54126-9254
Mailing Address - Country:US
Mailing Address - Phone:920-864-7307
Mailing Address - Fax:
Practice Address - Street 1:535 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3735
Practice Address - Country:US
Practice Address - Phone:920-921-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001821-15122300000X
WI100182115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist