MEDICARE: DARRELL G. DAY, DDS PA

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	20868	TX

General Provider Information

NPI Number	:	1306243043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARRELL G. DAY, DDS PA

Provider Business Mailing Address
First Line	:	4501 MATLOCK RD
Second Line	:	SUITE 301
City	:	ARLINGTON
State	:	TX
Zip	:	76018-1004
Country	:	US
Telephone Number	:	817-472-0888
Fax Number	:	817-472-9753

Provider Business Practice Location Address
First Line	:	4501 MATLOCK RD
Second Line	:	SUITE 301
City	:	ARLINGTON
State	:	TX
Zip	:	76018-1004
Country	:	US
Telephone Number	:	817-472-0888
Fax Number	:	817-472-9753

Authorized Official
Title or Position	:	OWNER / DENTIST
Name	:	DARRELL G DAY
Credential	:	DDS
Telephone Number	:	817-472-0888

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	11/24/2014

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