Provider Demographics
NPI:1871658021
Name:MARTINKOVIC, STEPHEN WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:MARTINKOVIC
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 1:1115 HICKS BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2867
Mailing Address - Country:US
Mailing Address - Phone:513-829-8844
Mailing Address - Fax:513-829-8845
Practice Address - Street 1:1115 HICKS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2867
Practice Address - Country:US
Practice Address - Phone:513-829-8844
Practice Address - Fax:513-829-8845
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH149731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice