1730275967 NPI number — DANIEL K MARTISIUS D.D.S., M.S.

Table of content: DANIEL K MARTISIUS D.D.S., M.S. (NPI 1730275967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730275967 NPI number — DANIEL K MARTISIUS D.D.S., M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTISIUS
Provider First Name:
DANIEL
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S., M.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730275967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 FORSYTHE BYPASS
Provider Second Line Business Mailing Address:
SUITE 116
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-388-2220
Provider Business Mailing Address Fax Number:
318-388-2219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 FORSYTHE BYPASS
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-388-2220
Provider Business Practice Location Address Fax Number:
318-388-2219
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  4436 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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