Lance P Martin, DMD Valid NPI
Individual provider · General Practice Dentistry · O Fallon, IL
- NPI
- 1326215484
- Type
- Individual (Type 1)
- Primary specialty
- General Practice Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223G0001X
- License number
- 19025240 (IL)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2008-05-08
- Last updated
- 2008-05-08
Practice location
904 E Highway 50
O Fallon, IL 62269-2813
(681) 632-8471