Provider Demographics
NPI:1073367819
Name:MARTINO, JONATHAN SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:MARTINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 ALDEN DR
Mailing Address - Street 2:
Mailing Address - City:FE WARREN AFB
Mailing Address - State:WY
Mailing Address - Zip Code:82005-2945
Mailing Address - Country:US
Mailing Address - Phone:307-773-5635
Mailing Address - Fax:307-773-3399
Practice Address - Street 1:6900 ALDEN DR
Practice Address - Street 2:
Practice Address - City:FE WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005-2945
Practice Address - Country:US
Practice Address - Phone:307-773-5635
Practice Address - Fax:307-773-3399
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist