NPIMap

Organization Active NPI

Bryan B. Martin, DMD, LLC

  • General Practice Dentistry
  • Magnolia, MS
National Provider Identifier
1710278429
Registry record updated Apr 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3453.08 Issued in MS
Legal business name
BRYAN B. MARTIN, DMD, LLC
Practice address
405 N Clark Ave
Magnolia, MS 39652-2609
Phone
(601) 783-2606
Fax
(601) 783-0572
NPI assigned
Apr 28, 2011
Last updated
Apr 28, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2011

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

Authorized official

Name
Dr. Bryan B Martin, DMDNPI 1932300977
Title
Doctor/Owner
Phone
(601) 783-2606

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 22474 TX
General Practice Dentistry 1223G0001X 3453.08 MS Primary

Addresses

Primary practice location

405 N Clark Ave
Magnolia, MS 39652-2609

Mailing address

405 N Clark Ave
Magnolia, MS 39652-2609
Phone (601) 783-2606

Other identifiers 2

IdentifierTypeStateIssuer
07575621MedicaidMS
1932300977OtherMSINDIVIDUAL NPI

National Provider Directory

National Provider Directory

Locations

405 N Clark Ave
Magnolia, MS 39652
Phone (601) 783-2606

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303948800000",
    "number": "1710278429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 N CLARK AVE",
            "city": "MAGNOLIA",
            "state": "MS",
            "postal_code": "396522609",
            "telephone_number": "601-783-2606",
            "fax_number": "601-783-0572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 N CLARK AVE",
            "city": "MAGNOLIA",
            "state": "MS",
            "postal_code": "396522609",
            "telephone_number": "601-783-2606",
            "fax_number": "601-783-0572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN B. MARTIN, DMD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-28",
        "last_updated": "2011-04-28",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "601-783-2606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22474",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3453.08",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07575621",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1932300977",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Magnolia, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2011; 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.