Individual provider Active NPI

David Lynn Martin, DDS

  • General Practice Dentistry
  • Waverly, OH
National Provider Identifier
1760693162
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30016453 Issued in OH
Practice address
106 Caudill Rd
Waverly, OH 45690-1001
Phone
(740) 947-9380
NPI assigned
May 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30016453 OH Primary

Addresses

Primary practice location

106 Caudill Rd
Waverly, OH 45690-1001

Mailing address

106 Caudill Rd
Waverly, OH 45690-1001
Phone (740) 947-9380

Other identifiers 1

IdentifierTypeStateIssuer
0464171MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20161102002910 OH Order and Referring Only - DentistPractitioner - Dentist 8820376338

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30016453OHMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760693162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 CAUDILL RD",
            "city": "WAVERLY",
            "state": "OH",
            "postal_code": "456901001",
            "telephone_number": "740-947-9380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 CAUDILL RD",
            "city": "WAVERLY",
            "state": "OH",
            "postal_code": "456901001",
            "telephone_number": "740-947-9380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "DAVID",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30016453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0464171",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waverly, OH

Sources for this page

Verify at the official NPI Registry.