MEDICARE: DR. SAMUEL FLETCHER KITCHING JR. 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	14529	TX

General Provider Information

NPI Number	:	1619095288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL FLETCHER KITCHING JR. DDS

Provider Business Mailing Address
First Line	:	614 ARCH ADAMS ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2139
Country	:	US
Telephone Number	:	817-335-2353
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 ARCH ADAMS ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2139
Country	:	US
Telephone Number	:	817-335-2353
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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