Healthcare Provider Details

I. General information

NPI: 1316571383
Provider Name (Legal Business Name): NICOLE MARTINO DMD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 07/24/2021
Certification Date: 07/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7603 SEMINOLE BLVD STE B
SEMINOLE FL
33772-4888
US

IV. Provider business mailing address

7603 SEMINOLE BLVD STE B
SEMINOLE FL
33772-4888
US

V. Phone/Fax

Practice location:
  • Phone: 727-391-0269
  • Fax:
Mailing address:
  • Phone: 727-391-0269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE MARTINO
Title or Position: PRESIDENT
Credential: DMD
Phone: 727-391-0269