Provider Demographics
NPI:1982067153
Name:DR. ROBERT MARTINO, PLLC
Entity Type:Organization
Organization Name:DR. ROBERT MARTINO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-933-5300
Mailing Address - Street 1:2000 INDUSTRIAL RD E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1297
Mailing Address - Country:US
Mailing Address - Phone:304-933-5300
Mailing Address - Fax:304-933-3633
Practice Address - Street 1:1402 BUCKHANNON PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:NUTTER FORT
Practice Address - State:WV
Practice Address - Zip Code:26301-4494
Practice Address - Country:US
Practice Address - Phone:304-933-5300
Practice Address - Fax:304-933-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3070122300000X
WV39631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty