Provider Demographics
NPI:1023277605
Name:METTUS, RONALD ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ALAN
Last Name:METTUS
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 1:205 DWELLINGTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059
Mailing Address - Country:US
Mailing Address - Phone:724-898-1155
Mailing Address - Fax:724-898-1427
Practice Address - Street 1:205 DWELLINGTON CIRCLE
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:PA
Practice Address - Zip Code:16059
Practice Address - Country:US
Practice Address - Phone:724-898-1155
Practice Address - Fax:724-898-1427
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026151L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist