Provider Demographics
NPI:1487694097
Name:MARTINO, RICHARD P (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
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 1:900 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1674
Mailing Address - Country:US
Mailing Address - Phone:847-234-3390
Mailing Address - Fax:847-234-3391
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:SUITE 208
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-234-3390
Practice Address - Fax:847-234-3391
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0106X, 122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL524480Medicare ID - Type Unspecified
ILT37088Medicare UPIN