MEDICARE: DR. ALEXANDER DAVID METZLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1001175-15	WI

General Provider Information

NPI Number	:	1538543319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER DAVID METZLER DDS

Provider Business Mailing Address
First Line	:	341 LAVERNE DR APT 5
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4734
Country	:	US
Telephone Number	:	608-769-0065
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 UNIVERSITY AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-3637
Country	:	US
Telephone Number	:	920-437-7444
Fax Number	:	920-437-7868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2015
Last Update Date	:	08/18/2015

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