Provider Demographics
NPI:1427261122
Name:METLER, MARTIN JERRY (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JERRY
Last Name:METLER
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 1:3962 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5248
Mailing Address - Country:US
Mailing Address - Phone:248-524-2000
Mailing Address - Fax:248-524-2307
Practice Address - Street 1:3962 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5248
Practice Address - Country:US
Practice Address - Phone:248-524-2000
Practice Address - Fax:248-524-2307
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010102461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice