Jacob David Martin, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6001570-15 Issued in WI

Practice address

1851 County Road XX
Kronenwetter, WI 54455-7933

Phone

(715) 359-0550

NPI assigned

May 22, 2023

Last updated

Jul 22, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1700578697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 GLADE CT APT 11",
            "city": "KRONENWETTER",
            "state": "WI",
            "postal_code": "544557333",
            "telephone_number": "423-710-6078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 COUNTY ROAD XX",
            "city": "KRONENWETTER",
            "state": "WI",
            "postal_code": "544557933",
            "telephone_number": "715-359-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JACOB",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6001570-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Fritz, PTA
• Michelle Lynn Jensen, CRNA
• Sierra Rae Krall, APNP, FNP
• Kristen Marie Lee, D.C.
• Tou Shoua John Lor, MD
• Rebecca Ann Mielke, APNP
• Music Therapy Services of Central Wisconsin, LLC
• Samantha Jo Nelson, RN
• Kristina Kay Neyrinck, MS, LPC
• Michelle Oshasky

• General Practice Dentistry in Kronenwetter, WI
• Providers in Kronenwetter, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.