Provider Demographics
NPI:1174557565
Name:DEMARTINO, SAM PETER (DDS)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:PETER
Last Name:DEMARTINO
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 1:911 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4612
Mailing Address - Country:US
Mailing Address - Phone:912-352-2289
Mailing Address - Fax:912-352-2042
Practice Address - Street 1:911 E 67TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4612
Practice Address - Country:US
Practice Address - Phone:912-352-2289
Practice Address - Fax:912-352-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51131223E0200X
GADN0137531223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics