Provider Demographics
NPI:1700140126
Name:MARTINO, DAVID FRANK JR
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FRANK
Last Name:MARTINO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 LISTRAVIA AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-6318
Mailing Address - Country:US
Mailing Address - Phone:304-292-4412
Mailing Address - Fax:
Practice Address - Street 1:1830 LISTRAVIA AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-6318
Practice Address - Country:US
Practice Address - Phone:304-292-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist