Provider Demographics
NPI:1801644299
Name:METTEY, MADISON (DDS)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:
Last Name:METTEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 W HUBBARD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-6414
Mailing Address - Country:US
Mailing Address - Phone:513-484-6666
Mailing Address - Fax:
Practice Address - Street 1:4104 BROADWAY STE D
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3065
Practice Address - Country:US
Practice Address - Phone:614-871-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0275161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice