Active NPI
Richard Dale Martinez, DDS
- Dentist
- SLC, UT
National Provider Identifier
1689705782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 275081-9922
- Practice address
- 2936 Highland Dr Ste 101
SLC, UT 84106-3583 - Phone
- (801) 467-6555
- Fax
- (801) 474-0103
- NPI assigned
- Mar 8, 2007
- 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 | 275081-9922 | UT | Primary |
Addresses
Primary practice location
2936 Highland Dr Ste 101
SLC, UT 84106-3583
Mailing address
2936 Highland Dr Ste 101
SLC, UT 84106-3583
Phone (801) 467-6555
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 115674 | Medicaid | MT | |
| 793952 | Other | UNITED CONCORDIA | |
| 0018294 | Medicaid | NM | |
| 87384051 | Medicaid | NM | |
| DD275UT | Medicaid | AK | |
| G91893-01 | Medicaid | CA | |
| 143256 | Medicaid | SD | |
| 1017004720001 | Medicaid | PA | |
| 817463 | Medicaid | AZ |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 275081-9922 | UT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1689705782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2936 HIGHLAND DR STE 101",
"city": "SLC",
"state": "UT",
"postal_code": "841063583",
"telephone_number": "801-467-6555",
"fax_number": "801-474-0103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2936 HIGHLAND DR STE 101",
"city": "SLC",
"state": "UT",
"postal_code": "841063583",
"telephone_number": "801-467-6555",
"fax_number": "801-474-0103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "RICHARD",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-08",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "275081-9922",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "115674",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "793952",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018294",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "87384051",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DD275UT",
"state": "AK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "G91893-01",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "143256",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1017004720001",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "817463",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in SLC, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.