Brendaliz Bristol Martir, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02545300 Issued in NJ

Practice address

2550 S Main Rd
Vineland, NJ 08360-7138

Phone

(856) 839-7019

NPI assigned

Jul 27, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Previously, effective Sep 8, 2020 through Sep 8, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• South Jersey Pediatric Dental, LLC

  • Pediatric Dentistry
  • Vineland, NJ
  • NPI 1598199101
  NPD Authorized official

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

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625875200000",
    "number": "1356697361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 S MAIN RD",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083607138",
            "telephone_number": "856-839-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 S MAIN RD",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083607138",
            "telephone_number": "856-839-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISTOL MARTIR",
        "first_name": "BRENDALIZ",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-27",
        "last_updated": "2021-07-10",
        "certification_date": "2021-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02545300",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PR",
            "license": "2867",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Michael Brenner II, PA-C, ATC
• Saul Bresalier, D.O.
• Brian Jagirdar DMD,PA (Vineland Dental Arts)
• Bright Side Wellness LLC
• Brianna Brion
• Anwyn Blythe Brock, PA
• Margaret Brooks
• Yvonne Brooks, LPN
• Brian Brown, PAC
• Ciara Brown

• Dentist in Vineland, NJ
• Providers in Vineland, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.