Provider Demographics
NPI:1194730549
Name:DETTMER, MARTIN ARTHUR (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ARTHUR
Last Name:DETTMER
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 1:531 E ROOSEVELT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5583
Mailing Address - Country:US
Mailing Address - Phone:630-665-5550
Mailing Address - Fax:630-665-5554
Practice Address - Street 1:531 E ROOSEVELT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5583
Practice Address - Country:US
Practice Address - Phone:630-665-5550
Practice Address - Fax:630-665-5554
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A14036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist