Clark W Martineau, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.022745 Issued in IL

Practice address

1500 N Westwood Blvd
Poplar Bluff, MO 63901-3318

Phone

(573) 778-4630

NPI assigned

Sep 16, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382572800000",
    "number": "1598861445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3032 SADDLEBROOK TRL",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639011579",
            "telephone_number": "573-727-9352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013318",
            "telephone_number": "573-778-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEAU",
        "first_name": "CLARK",
        "middle_name": "W",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2013-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.022745",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.022745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Monica Mason, LPN
• Anthony Travis Massa
• Morgan Massey
• Heather Massie
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• General Practice Dentistry in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.