Provider Demographics
NPI:1114142031
Name:MARTINO, JAMES M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:MARTINO
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 1:35 CATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3411
Mailing Address - Country:US
Mailing Address - Phone:814-371-7563
Mailing Address - Fax:814-371-7563
Practice Address - Street 1:221 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:PA
Practice Address - Zip Code:15865-1305
Practice Address - Country:US
Practice Address - Phone:814-371-7563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015924L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice