Martin, DDS PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

3827 Issued in WV

Legal business name

MARTIN, DDS PLLC

Practice address

140 7TH Ave
South Charlestown, WV 25303

Phone

(304) 342-4422

Fax

(304) 400-4986

NPI assigned

Oct 16, 2013

Last updated

Jun 17, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jarrel R Martin II, DDS

Title

Member/Owner

Phone

(304) 419-0125

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Young Smiles WV Other name

Locations

Practitioners 2

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.

• Jarrell Richard Martin II, DDS

  • General Practice Dentistry
  • Charleston, WV
  • NPI 1750675419
  NPD (past)
• Kendra Dawn Martin, D.D.S.

  • General Practice Dentistry
  • Charleston, WV
  • NPI 1619130085
  NPD (past)

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1760810444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 7TH AVE",
            "city": "SOUTH CHARLESTOWN",
            "state": "WV",
            "postal_code": "25303",
            "telephone_number": "304-342-4422",
            "fax_number": "304-400-4986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 7TH AVE",
            "city": "SOUTH CHARLESTOWN",
            "state": "WV",
            "postal_code": "25303",
            "telephone_number": "304-342-4422",
            "fax_number": "304-400-4986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN, DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JARREL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "304-419-0125",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WV",
            "license": "3945",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WV",
            "license": "3827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810000582",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Young Smiles WV",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Young Smiles WV",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; 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.