Provider Demographics
NPI:1538168794
Name:MARTELLO, JEFFREY J (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:MARTELLO
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 1:4376 BLUFFTON PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4755
Mailing Address - Country:US
Mailing Address - Phone:843-706-9600
Mailing Address - Fax:
Practice Address - Street 1:4376 BLUFFTON PKWY STE 103
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4755
Practice Address - Country:US
Practice Address - Phone:843-706-9600
Practice Address - Fax:843-706-9602
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9481122300000X
SC9481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist