Provider Demographics
NPI:1912075839
Name:MARTSCH, WILLIAM FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:MARTSCH
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 1:315 N. WHITLEY
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619
Mailing Address - Country:US
Mailing Address - Phone:208-452-2722
Mailing Address - Fax:208-642-8941
Practice Address - Street 1:315 N. WHITLEY
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619
Practice Address - Country:US
Practice Address - Phone:208-452-2722
Practice Address - Fax:208-642-8941
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD30761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001016600Medicaid