Crystal Martin DDS LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CRYSTAL MARTIN DDS LLC

Practice address

277 Clarkson Rd Ste 100
Ellisville, MO 63011-2280

Phone

(636) 227-0507

Fax

(636) 591-0032

NPI assigned

Apr 6, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Crystal L Martin, DDSNPI 1396758793

Title

Dentist/Owner

Phone

(636) 227-0507

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 1

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

• Crystal Martin, D.D.S.

  • General Practice Dentistry
  • Ellisville, MO
  • NPI 1396758793
  NPD Authorized official

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

{
    "created_epoch": "1617667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622678400000",
    "number": "1609455633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 PORTICO CT",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172536",
            "telephone_number": "314-488-9073"
        },
        {
            "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": "630112280",
            "telephone_number": "636-227-0507",
            "fax_number": "636-591-0032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL MARTIN DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-06",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "636-227-0507",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Crystal Martin DDS
• Mary Patricia Curtis, RN NP-C
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• Keana Tena Daigle
• Saundra Daugherty, SLP
• Leonard Gerfield David, CSFA

• 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 Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.