Provider Demographics
NPI:1699854760
Name:MARTINO, JOSEPH CARMINE (DMD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CARMINE
Last Name:MARTINO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2223
Mailing Address - Country:US
Mailing Address - Phone:631-473-0582
Mailing Address - Fax:631-473-3525
Practice Address - Street 1:714 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2223
Practice Address - Country:US
Practice Address - Phone:631-473-0582
Practice Address - Fax:631-473-3525
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0448121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice