Active NPI
Martin Charles Roberts, D.D.S.
- General Practice Dentistry
- Boulder, CO
National Provider Identifier
1730474727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 105347
- Practice address
- 1900 Folsom St
Suite 111
Boulder, CO 80302-5713 - Phone
- (303) 442-4810
- Fax
- (303) 415-9155
- NPI assigned
- Jun 17, 2011
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 105347 | CO | Primary |
Addresses
Primary practice location
1900 Folsom St
Suite 111
Boulder, CO 80302-5713
Mailing address
1900 Folsom St
Suite 111
Boulder, CO 80302-5713
Phone (303) 442-4810
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 |
|---|---|---|---|
| 105347 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308268800000",
"number": "1730474727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 FOLSOM ST",
"address_2": "SUITE 111",
"city": "BOULDER",
"state": "CO",
"postal_code": "803025713",
"telephone_number": "303-442-4810",
"fax_number": "303-415-9155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 FOLSOM ST",
"address_2": "SUITE 111",
"city": "BOULDER",
"state": "CO",
"postal_code": "803025713",
"telephone_number": "303-442-4810",
"fax_number": "303-415-9155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "MARTIN",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-17",
"last_updated": "2011-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "105347",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.