Healthcare Provider Details

I. General information

NPI: 1649231663
Provider Name (Legal Business Name): RONALD MARTELLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 HILTON RD SUITE #1
FERNDALE MI
48220-1459
US

IV. Provider business mailing address

23703 OLD ORCHARD TRL
BINGHAM FARMS MI
48025-3446
US

V. Phone/Fax

Practice location:
  • Phone: 248-545-6400
  • Fax:
Mailing address:
  • Phone: 248-647-7291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12200
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: