Provider Demographics
NPI:1902066053
Name:MARTIN, JANE KNIGHT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:KNIGHT
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 W PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8190
Mailing Address - Country:US
Mailing Address - Phone:414-764-6760
Mailing Address - Fax:
Practice Address - Street 1:1001 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-2500
Practice Address - Country:US
Practice Address - Phone:414-764-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33718400Medicare PIN