Ivan A Martino, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

1001205 Issued in WI

Practice address

10347 77TH St
Suite 630
Pleasant Prairie, WI 53158-1137

Phone

(262) 694-6360

NPI assigned

Feb 21, 2015

Last updated

Apr 12, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Affordable Dentures & Implants - Kenosha III, S.C.

  dba Affordable Dentures & Implants - Kenosha

  • General Practice Dentistry
  • Pleasant Prairie, WI
  • NPI 1104647957
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491955200000",
    "number": "1487046991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10347 77TH ST",
            "address_2": "SUITE 630",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531581137",
            "telephone_number": "262-694-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10347 77TH ST",
            "address_2": "SUITE 630",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531581137",
            "telephone_number": "262-694-6360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINO",
        "first_name": "IVAN",
        "middle_name": "A",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-02-21",
        "last_updated": "2017-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030078",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1001205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth M Martin, P.A.
• Carolina Martinez
• Clarisa E Martinez
• John A Martini, MD
• Matthew Martini, M.D
• Gerald Maryanov, DPT
• Byron Mathews
• Myles D Maxwell, RN
• Cathy McClay, PT
• Douglas Marion McDaniel, PTA

• Dentist in Pleasant Prairie, WI
• Providers in Pleasant Prairie, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.