Individual provider Active NPI

Martin W Roberson, DDS

  • Dentist
  • Knoxville, TN
National Provider Identifier
1568657591
Registry record updated Jun 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8949 Issued in TN
Practice address
310 Simmons Rd
Ste. I
Knoxville, TN 37922-1943
Phone
(865) 675-3009
Fax
(865) 675-3028
NPI assigned
Sep 12, 2007
Last updated
Jun 10, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 3575 AR
Dentist 122300000X 8949 TN Primary

Addresses

Primary practice location

310 Simmons Rd
Ste. I
Knoxville, TN 37922-1943

Mailing address

310 Simmons Rd
Suite I
Knoxville, TN 37922-1943
Phone (865) 675-3009

Other identifiers 1

IdentifierTypeStateIssuer
VAD000OtherUPIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3575ARMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370822400000",
    "number": "1568657591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 SIMMONS RD",
            "address_2": "SUITE I",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379221943",
            "telephone_number": "865-675-3009",
            "fax_number": "865-675-3028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 SIMMONS RD",
            "address_2": "STE. I",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379221943",
            "telephone_number": "865-675-3009",
            "fax_number": "865-675-3028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "MARTIN",
        "middle_name": "W",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-12",
        "last_updated": "2013-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "3575",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "8949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "VAD000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2013; 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.