Crystal Martin, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15403 Issued in MO

Practice address

277 Clarkson Rd, Ste 100
Ellisville, MO 63011

Phone

(636) 227-0507

Fax

(636) 591-0032

NPI assigned

Aug 15, 2006

Sex

Female

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

Enrolled in MO

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

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Crystal Martin DDS

  • Dental Clinic/Center
  • Ellisville, MO
  • NPI 1992381594
  NPD Authorized official
• Crystal Martin DDS LLC

  • General Practice Dentistry
  • Ellisville, MO
  • NPI 1609455633
  NPD Authorized official

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454025600000",
    "number": "1396758793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 CLARKSON RD, STE 100",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "63011",
            "telephone_number": "636-227-0507",
            "fax_number": "636-591-0032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 CLARKSON RD, STE 100",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "63011",
            "telephone_number": "636-227-0507",
            "fax_number": "636-591-0032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CRYSTAL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2016-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "15403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Renee Ma
• Marcello Macellaio, DC
• Giovanna Mancuso
• Matthew John Markelz, ATC
• Jeffrey L Marlow, R.PH.
• Tammy L. Martin, M.D.
• Jason Forrest Mathers, PH.D., LPC
• Anna T McCarthy, M.S., CCC-SLP
• Joan M McCourt, ANP
• James Austin McDaniel III, D.C.

• General Practice Dentistry in Ellisville, MO
• Providers in Ellisville, 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 Jan 29, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.