Provider Demographics
NPI:1396963740
Name:DANIEL K. MARTISIUS, D.D.S., M.S
Entity type:Organization
Organization Name:DANIEL K. MARTISIUS, D.D.S., M.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARTISIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:318-388-2220
Mailing Address - Street 1:5000 FORSYTHE BYPASS
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:70201
Mailing Address - Country:US
Mailing Address - Phone:318-388-2220
Mailing Address - Fax:318-388-2219
Practice Address - Street 1:5000 FORSYTHE BYPASS
Practice Address - Street 2:SUITE 116
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:70201
Practice Address - Country:US
Practice Address - Phone:318-388-2220
Practice Address - Fax:318-388-2219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty