Provider Demographics
NPI:1780720342
Name:MARTIN, WILLIAM ERIC (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ERIC
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 1:1807 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9476
Mailing Address - Country:US
Mailing Address - Phone:217-355-9997
Mailing Address - Fax:217-355-1970
Practice Address - Street 1:1807 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9476
Practice Address - Country:US
Practice Address - Phone:217-355-9997
Practice Address - Fax:217-355-1970
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19024794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist