Individual provider Active NPI

Kevin M Altieri, D.D.S.

  • General Practice Dentistry
  • Fort Worth, TX
National Provider Identifier
1003967068
Registry record updated Nov 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
16950 Issued in TX
Practice address
5521 Bellaire Dr S
Suite202
Fort Worth, TX 76109-8838
Phone
(817) 294-5513
NPI assigned
Jan 16, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 16950 TX Primary

Addresses

Primary practice location

5521 Bellaire Dr S
Suite202
Fort Worth, TX 76109-8838

Mailing address

5521 Bellaire Dr S
Suite 202
Fort Worth, TX 76109-8838
Phone (817) 294-5513

Other names 1

  • Dr. Kevin M Martinez Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20160119002200 TX Order and Referring Only - DentistPractitioner - Dentist 8022311455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16950TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Altieri Dental,PC General Practice Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447804800000",
    "number": "1003967068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5521 BELLAIRE DR S",
            "address_2": "SUITE 202",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761098838",
            "telephone_number": "817-294-5513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5521 BELLAIRE DR S",
            "address_2": "SUITE202",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761098838",
            "telephone_number": "817-294-5513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALTIERI",
        "first_name": "KEVIN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2015-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "16950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEVIN",
            "last_name": "MARTINEZ",
            "middle_name": "M",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.