# DRS WILSON AND MARTINO OF TEAYS VALLEY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174616304
- **Authorized official:** DR. ROBERT V MARTINO DDS (CEO)
- **Authorized official phone:** (304) 624-5250

## Contact information

- **Practice address:** 4113 TEAYS VALLEY RD, SCOTT DEPOT, WV 25560-9740
- **Practice address phone:** (304) 201-7645
- **Practice address fax:** (304) 757-3840
- **Mailing address:** 516 COST AVE, STONEWOOD, WV 26301-4811
- **Mailing address phone:** (304) 624-5250
- **Mailing address fax:** (304) 624-5251

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3070 | WV | Yes |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3810001573 | WV DENTAL MEDICAL CARD | WV |