Daryl John Martin, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10150 Issued in MO

Practice address

517 Main St
Fenton, MO 63026-4169

Phone

(636) 343-1550

Fax

(636) 343-1524

NPI assigned

May 16, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Martin Family Dental, LLC

  • General Practice Dentistry
  • Fenton, MO
  • NPI 1053346122
  NPD (past) Authorized official

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210896000000",
    "number": "1073770129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 MAIN ST",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630264169",
            "telephone_number": "636-343-1550",
            "fax_number": "636-343-1524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 MAIN ST",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630264169",
            "telephone_number": "636-343-1550",
            "fax_number": "636-343-1524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "DARYL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-16",
        "last_updated": "2008-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "10150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maple Grove Wellness & Rehabilitation LLC (Maple Grove Wellness & Rehabilitation)
• Marcio Guzman
• Matea Markovic
• Ryan Markus
• Martin Family Dental, LLC
• Mary Davisson Martin, PT
• Jerald A Maslanko, M.D.
• Stephanie L Massey, D.O.
• Michael Harry Mastromichalis, M.D.
• Matrix Psychiatric Home and Health Care, L.L.C.

• General Practice Dentistry in Fenton, MO
• Providers in Fenton, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.