MEDICARE: DR. AVERY MAKENZIE LANE MARTINO 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	122300000X	Dentist	27982	FL
2	122300000X	Dentist	MSDEN.00000008	CO

General Provider Information

NPI Number	:	1427752914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVERY MAKENZIE LANE MARTINO DDS

Provider Business Mailing Address
First Line	:	5955 DUBLIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-7474
Country	:	US
Telephone Number	:	719-793-1932
Fax Number	:

Provider Business Practice Location Address
First Line	:	5955 DUBLIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-7474
Country	:	US
Telephone Number	:	719-793-1932
Fax Number	:

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

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	06/03/2026

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