Kenneth R. Marti, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

# 27453 Issued in CA

Practice address

6049 Douglas Blvd
Suite 9
Granite Bay, CA 95746-6284

Phone

(916) 791-4133

Fax

(916) 791-1659

NPI assigned

Apr 17, 2007

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

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487879946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6049 DOUGLAS BLVD",
            "address_2": "SUITE 9",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957466284",
            "telephone_number": "916-791-4133",
            "fax_number": "916-791-1659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6049 DOUGLAS BLVD",
            "address_2": "SUITE 9",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957466284",
            "telephone_number": "916-791-4133",
            "fax_number": "916-791-1659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTI",
        "first_name": "KENNETH",
        "middle_name": "R.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "# 27453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dylan Manalo
• Margaret K. Smith Chiropractic, Inc.
• Marina Milstein DDS Inc
• Kanah-Kila Marquez
• Lilly Leona Martel
• Jerry H. Martin, DDS
• Shyanne Martinez
• Philip Matin, M.D.
• Kyle Matthews
• Urangoo Matthews

• General Practice Dentistry in Granite Bay, CA
• Providers in Granite Bay, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.