Martin D Phandl

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

105141 Issued in CA

Practice address

1291 E Hillsdale Blvd Ste 110
Foster City, CA 94404-1293

Phone

(650) 574-3612

NPI assigned

Jun 21, 2019

Last updated

Mar 6, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• 4TH Street Dental, PLLC

  dba Family Smiles of Lubbock

  • General Practice Dentistry
  • Lubbock, TX
  • NPI 1306347711
  NPD (past)

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

{
    "created_epoch": "1561075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1689235681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1291 E HILLSDALE BLVD STE 110",
            "city": "FOSTER CITY",
            "state": "CA",
            "postal_code": "944041293",
            "telephone_number": "650-574-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1291 E HILLSDALE BLVD STE 110",
            "city": "FOSTER CITY",
            "state": "CA",
            "postal_code": "944041293",
            "telephone_number": "650-574-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHANDL",
        "first_name": "MARTIN",
        "middle_name": "D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-21",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "35229",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Ostertag, D.P.T.
• Sergio Rodrigo Palza
• Derek Park, M.D., D.D.S.
• Nirali Patel, L.AC
• Tunan Peng, L.AC
• Jason Pierce
• Polly Chan DDS Inc
• Katrina M Polonsky, DMD
• Marilyn Denise Ponce de Leon, SCHOOL NURSE
• Carla Jean Porter-Pursnani, DPM

• General Practice Dentistry in Foster City, CA
• Providers in Foster City, 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 Mar 6, 2024; 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.