Provider Demographics
NPI:1407949639
Name:DRS MARTINO & WILSON, PLLC
Entity Type:Organization
Organization Name:DRS MARTINO & WILSON, PLLC
Other - Org Name:WILSON MARTINO DENTAL OF BUCKHANNON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-624-5250
Mailing Address - Street 1:516 COST AVE
Mailing Address - Street 2:
Mailing Address - City:STONEWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4811
Mailing Address - Country:US
Mailing Address - Phone:304-624-5250
Mailing Address - Fax:304-624-5251
Practice Address - Street 1:19 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2715
Practice Address - Country:US
Practice Address - Phone:304-472-4954
Practice Address - Fax:304-472-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001852OtherWV DENTAL MEDICAL CARD