Active NPI
William S Marietta, D.D.S.
- Dentist
- Albuquerque, NM
National Provider Identifier
1669622155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1415
- Practice address
- 717 Encino PL NE
Suite: 6
Albuquerque, NM 87102-2611 - Phone
- (505) 247-8005
- Fax
- (505) 843-8589
- NPI assigned
- Sep 22, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1415 | NM | Primary |
Addresses
Primary practice location
717 Encino PL NE
Suite: 6
Albuquerque, NM 87102-2611
Mailing address
717 Encino PL NE
Suite: 6
Albuquerque, NM 87102-2611
Phone (505) 247-8005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Previously, effective Aug 16, 2016 through Aug 16, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1415 | NM | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222041600000",
"number": "1669622155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "717 ENCINO PL NE",
"address_2": "SUITE: 6",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871022611",
"telephone_number": "505-247-8005",
"fax_number": "505-843-8589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "717 ENCINO PL NE",
"address_2": "SUITE: 6",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871022611",
"telephone_number": "505-247-8005",
"fax_number": "505-843-8589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARIETTA",
"first_name": "WILLIAM",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-22",
"last_updated": "2008-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "1415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.