NPIMap

Organization Active NPI

Fort Theatre Dentistry

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Kearney, NE
National Provider Identifier
1568670537
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
FORT THEATRE DENTISTRY
Practice address
2205 Central Ave
Kearney, NE 68847-5346
Phone
(308) 237-5853
Fax
(308) 237-5089
NPI assigned
May 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Dr. Walter D Martin, DMDNPI 1548483845
Title
Owner
Phone
(308) 237-5853

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

2205 Central Ave
Kearney, NE 68847-5346

Mailing address

2205 Central Ave
Kearney, NE 68847-5346
Phone (308) 237-5853

Other identifiers 1

IdentifierTypeStateIssuer
100252764-00MedicaidNE

National Provider Directory

National Provider Directory

Locations

2205 Central Ave
Kearney, NE 68847
Phone (308) 237-5853

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1568670537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 CENTRAL AVE",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688475346",
            "telephone_number": "308-237-5853",
            "fax_number": "308-237-5089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 CENTRAL AVE",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688475346",
            "telephone_number": "308-237-5853",
            "fax_number": "308-237-5089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT THEATRE DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "308-237-5853",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100252764-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kearney, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.