Provider Demographics
NPI:1134138159
Name:DIMARTINO, MARK VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:VINCENT
Last Name:DIMARTINO
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 1:1375 HATHAWAY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-8804
Mailing Address - Country:US
Mailing Address - Phone:585-924-2160
Mailing Address - Fax:585-924-1875
Practice Address - Street 1:1375 HATHAWAY DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-8804
Practice Address - Country:US
Practice Address - Phone:585-924-2160
Practice Address - Fax:585-924-1875
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0523501223G0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies