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Organization
DR. K. P. WILSON, PLLC
Active
Organization
DR. K. P. WILSON, PLLC
Active
Other names
Wilson Martino Dental of Bridgeport
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT V MARTINO DDS (CEO)
(304) 624-5250
Entity
Organization
Contact information
Practice address
930 W MAIN ST, BRIDGEPORT, WV 26330-1673
(304) 842-7568
(304) 842-2202
Mailing address
516 COST AVE, STONEWOOD, WV 26301-4811
(304) 624-5250
(304) 624-5251
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3070
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3810001853
WV DENTAL MEDICAL CARD
WV
Enumeration date
09/21/2006
Last updated
08/22/2020
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