Provider Demographics
NPI:1376619981
Name:KETTLER, RONALD EUGENE (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EUGENE
Last Name:KETTLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 EAST MAIN STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5864
Mailing Address - Country:US
Mailing Address - Phone:765-966-6215
Mailing Address - Fax:765-965-1822
Practice Address - Street 1:2519 EAST MAIN STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5864
Practice Address - Country:US
Practice Address - Phone:765-966-6215
Practice Address - Fax:765-965-1822
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120072011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice