Provider Demographics
NPI:1730275967
Name:MARTISIUS, DANIEL K (DDS, MS)
Entity type:Individual
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First Name:DANIEL
Middle Name:K
Last Name:MARTISIUS
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:5000 FORSYTHE BYPASS
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:70201
Mailing Address - Country:US
Mailing Address - Phone:318-388-2220
Mailing Address - Fax:318-388-2219
Practice Address - Street 1:5000 FORSYTHE BYPASS
Practice Address - Street 2:SUITE 116
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:70201
Practice Address - Country:US
Practice Address - Phone:318-388-2220
Practice Address - Fax:318-388-2219
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA44361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics