1427056506 NPI number — ROBERT LOUIS MARTINICH DMD

Table of content: ROBERT LOUIS MARTINICH DMD (NPI 1427056506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427056506 NPI number — ROBERT LOUIS MARTINICH DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINICH
Provider First Name:
ROBERT
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427056506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W COUNTY LINE RD
Provider Second Line Business Mailing Address:
STE. 250
Provider Business Mailing Address City Name:
HIGHLANDS RANCH
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80129-2360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-791-0160
Provider Business Mailing Address Fax Number:
303-791-4286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W COUNTY LINE RD
Provider Second Line Business Practice Location Address:
STE. 250
Provider Business Practice Location Address City Name:
HIGHLANDS RANCH
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80129-2360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-791-0160
Provider Business Practice Location Address Fax Number:
303-791-4286
Provider Enumeration Date:
07/12/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  104843 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)