Provider Demographics
NPI:1427056506
Name:MARTINICH, ROBERT LOUIS (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LOUIS
Last Name:MARTINICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W COUNTY LINE RD
Mailing Address - Street 2:STE. 250
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2360
Mailing Address - Country:US
Mailing Address - Phone:303-791-0160
Mailing Address - Fax:303-791-4286
Practice Address - Street 1:200 W COUNTY LINE RD
Practice Address - Street 2:STE. 250
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2360
Practice Address - Country:US
Practice Address - Phone:303-791-0160
Practice Address - Fax:303-791-4286
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1048431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice