Provider Demographics
NPI:1669574513
Name:MARTIN, TODD C (DDS)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9435 W. OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513
Mailing Address - Country:US
Mailing Address - Phone:708-485-0016
Mailing Address - Fax:708-485-0024
Practice Address - Street 1:9435 W. OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513
Practice Address - Country:US
Practice Address - Phone:708-485-0016
Practice Address - Fax:708-485-0024
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist