Provider Demographics
NPI:1720041353
Name:MATACALE, RALPH ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ANTHONY
Last Name:MATACALE
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 1:6602 LITTLE SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-8191
Mailing Address - Country:US
Mailing Address - Phone:812-421-1315
Mailing Address - Fax:
Practice Address - Street 1:2302 U.S. HIGHWAY 60 EAST
Practice Address - Street 2:EARL C CLEMENT JOB CORPS ACADEMY
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437
Practice Address - Country:US
Practice Address - Phone:270-389-5651
Practice Address - Fax:270-389-5303
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009711122300000X
KY6665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200262160BMedicaid