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General NPI Number Information
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NPI Number | 1649231663
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Entity Type | Individual
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Provider Name | RONALD MARTELLA DDS
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2241 HILTON RD SUITE #1
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City | FERNDALE
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State | MI
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Zip | 48220-1459
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Country | US
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Telephone | 248-545-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 23703 OLD ORCHARD TRL
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-3446
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Country | US
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Telephone | 248-647-7291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12200
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License Number State | MI
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