Provider Demographics
NPI:1316571383
Name:NICOLE MARTINO DMD, P.A.
Entity Type:Organization
Organization Name:NICOLE MARTINO DMD, P.A.
Other - Org Name:INNOVATIVE DENTAL SOLUTIONS OF SEMINOLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-391-0269
Mailing Address - Street 1:7603 SEMINOLE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4888
Mailing Address - Country:US
Mailing Address - Phone:727-391-0269
Mailing Address - Fax:
Practice Address - Street 1:7603 SEMINOLE BLVD STE B
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4888
Practice Address - Country:US
Practice Address - Phone:727-391-0269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies