Active NPI
Martin Ralph Szakaly, D.D.S.
- Dentist
- South Bend, IN
National Provider Identifier
1750466280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12007671A
- Practice address
- 2911 Lincoln Way West
South Bend, IN 46628-1943 - Phone
- (574) 233-3565
- NPI assigned
- Oct 25, 2006
- 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 | 12007671A | IN | Primary |
Addresses
Primary practice location
2911 Lincoln Way West
South Bend, IN 46628-1943
Mailing address
2911 Lincoln Way West
South Bend, IN 46628-1943
Phone (574) 233-3565
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 35-1882785 | Other | IN | TAX ID |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750466280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2911 LINCOLN WAY WEST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466281943",
"telephone_number": "574-233-3565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2911 LINCOLN WAY WEST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466281943",
"telephone_number": "574-233-3565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SZAKALY",
"first_name": "MARTIN",
"middle_name": "RALPH",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12007671A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "35-1882785",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.