Healthcare Provider Details

I. General information

NPI: 1801644299
Provider Name (Legal Business Name): MADISON METTEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 BROADWAY STE D
GROVE CITY OH
43123-3065
US

IV. Provider business mailing address

76 W HUBBARD AVE
COLUMBUS OH
43215-6414
US

V. Phone/Fax

Practice location:
  • Phone: 614-871-0088
  • Fax:
Mailing address:
  • Phone: 513-484-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.027516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: