Provider Demographics
NPI:1649231663
Name:MARTELLA, RONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:MARTELLA
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 1:23703 OLD ORCHARD TRL
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3446
Mailing Address - Country:US
Mailing Address - Phone:248-647-7291
Mailing Address - Fax:
Practice Address - Street 1:2241 HILTON RD
Practice Address - Street 2:SUITE #1
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1459
Practice Address - Country:US
Practice Address - Phone:248-545-6400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI72795OtherCONCORDIA PPO
MI0005911-167OtherAETNA PPO
MI1837608Medicaid