Provider Demographics
NPI:1144324286
Name:MARTIN, ANTHONY PAUL (DDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PAUL
Last Name:MARTIN
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 1:912 N HILLCREST PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720
Mailing Address - Country:US
Mailing Address - Phone:715-835-8311
Mailing Address - Fax:715-835-4646
Practice Address - Street 1:912 N HILLCREST PARKWAY
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720
Practice Address - Country:US
Practice Address - Phone:715-835-8311
Practice Address - Fax:715-835-4646
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5870-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice