Provider Demographics
NPI:1023228251
Name:MARTIN, NOEL QUENTIN II (DMD)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:QUENTIN
Last Name:MARTIN
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7626 WYDOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2676
Mailing Address - Country:US
Mailing Address - Phone:314-721-5161
Mailing Address - Fax:314-721-5162
Practice Address - Street 1:7626 WYDOWN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2676
Practice Address - Country:US
Practice Address - Phone:314-721-5161
Practice Address - Fax:314-721-5162
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0121261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice