MEDICARE: DR. RICHARD DALE MARTINEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	275081-9922	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	793952	OTHER	UNITED CONCORDIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689705782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD DALE MARTINEZ DDS

Provider Business Mailing Address
First Line	:	2936 HIGHLAND DR STE 101
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84106-3583
Country	:	US
Telephone Number	:	801-467-6555
Fax Number	:	801-474-0103

Provider Business Practice Location Address
First Line	:	2936 HIGHLAND DR STE 101
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84106-3583
Country	:	US
Telephone Number	:	801-467-6555
Fax Number	:	801-474-0103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/09/2007

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