MEDICARE: DR. MARK VINCENT DIMARTINO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	052350	NY
2	332B00000X	Durable Medical Equipment & Medical Supplies	052350	NY

General Provider Information

NPI Number	:	1134138159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK VINCENT DIMARTINO DDS

Provider Business Mailing Address
First Line	:	1375 HATHAWAY DR
Second Line	:
City	:	FARMINGTON
State	:	NY
Zip	:	14425-8804
Country	:	US
Telephone Number	:	585-924-2160
Fax Number	:	585-924-1875

Provider Business Practice Location Address
First Line	:	1375 HATHAWAY DR
Second Line	:
City	:	FARMINGTON
State	:	NY
Zip	:	14425-8804
Country	:	US
Telephone Number	:	585-924-2160
Fax Number	:	585-924-1875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	09/16/2020

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