Provider Demographics
NPI:1851597330
Name:MARTINKA, SCOTT ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ADAM
Last Name:MARTINKA
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 1:12620 INDIAN BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SPICER
Mailing Address - State:MN
Mailing Address - Zip Code:56288-9695
Mailing Address - Country:US
Mailing Address - Phone:320-796-6796
Mailing Address - Fax:
Practice Address - Street 1:408 TROTT AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3280
Practice Address - Country:US
Practice Address - Phone:320-235-2922
Practice Address - Fax:320-231-1719
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND124481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice