Provider Demographics
NPI:1508041500
Name:MARTINI, SCOTT CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CHARLES
Last Name:MARTINI
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 1:4820 W TAFT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4865
Mailing Address - Country:US
Mailing Address - Phone:315-451-4900
Mailing Address - Fax:315-451-6192
Practice Address - Street 1:4820 W TAFT RD STE 101
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4865
Practice Address - Country:US
Practice Address - Phone:315-451-4900
Practice Address - Fax:315-451-6192
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0535511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice