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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