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General NPI Number Information
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NPI Number | 1851597330
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Entity Type | Individual
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Provider Name | SCOTT ADAM MARTINKA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 408 TROTT AVE SW
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City | WILLMAR
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State | MN
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Zip | 56201-3280
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Country | US
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Telephone | 320-235-2922
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Fax | 320-231-1719
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Provider Business Mailing Address
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Address Line | 12620 INDIAN BEACH RD
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City | SPICER
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State | MN
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Zip | 56288-9695
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Country | US
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Telephone | 320-796-6796
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12448
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License Number State | MN
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