Provider Demographics
NPI:1295908994
Name:MARTENS, ALENA MARIE HARRIS (DDS)
Entity type:Individual
Prefix:DR
First Name:ALENA
Middle Name:MARIE HARRIS
Last Name:MARTENS
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 1:412 ELM ST W
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4415
Mailing Address - Country:US
Mailing Address - Phone:651-323-7488
Mailing Address - Fax:
Practice Address - Street 1:1650 BEAM AVE STE 103
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1147
Practice Address - Country:US
Practice Address - Phone:651-770-7175
Practice Address - Fax:651-770-6109
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND122971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice