Provider Demographics
NPI:1912974213
Name:MARTINSON, JAMES W (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:MARTINSON
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 1:1001 W INTERSTATE AVE
Mailing Address - Street 2:SUITE 132
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503
Mailing Address - Country:US
Mailing Address - Phone:701-223-1476
Mailing Address - Fax:701-223-4503
Practice Address - Street 1:1001 W INTERSTATE AVE
Practice Address - Street 2:SUITE 132
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503
Practice Address - Country:US
Practice Address - Phone:701-223-1476
Practice Address - Fax:701-223-4503
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND18161223G0001X
MN106451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41269Medicaid