Provider Demographics
NPI:1124228390
Name:MARTINO, MEGAN D (DMD)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:D
Last Name:MARTINO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:PA
Mailing Address - Zip Code:18427
Mailing Address - Country:US
Mailing Address - Phone:570-689-7784
Mailing Address - Fax:570-689-7957
Practice Address - Street 1:15 FRUEHAN DRIVE
Practice Address - Street 2:ROUTE 590
Practice Address - City:HAMLIN
Practice Address - State:PA
Practice Address - Zip Code:18427
Practice Address - Country:US
Practice Address - Phone:570-689-7784
Practice Address - Fax:570-689-7957
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice