Corey D Martinez, DDS
Individual provider Active NPI Dentist · Alexandria, IN
NPI 1083094155 · NPPES record last updated Jan 20, 2023
Key facts
- NPI
- 1083094155
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12012410A (IN)
- Practice address
- 2204 S Park Ave
Alexandria, IN 46001-8059 - Phone
- (765) 724-7729
- NPI assigned
- Jun 4, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160505001060 | IN | Order and Referring Only - Dentist |
7416256821 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kluth Family Dentistry Inc. | Past |
Accepting new patients | |
| Corey Martinez DDS LLC- Binford | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12012410A | IN | Yes |
Addresses
Primary practice location
2204 S Park Ave
Alexandria, IN 46001-8059
Mailing address
10445 N College Ave
Carmel, IN 46280-1436
Phone (317) 846-3431
Other practice location 1
10445 N College Ave
Carmel, IN 46280-1436
Phone (317) 846-3431
Other providers in Alexandria, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.