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NPI Code Detail

MEDICARE: DR. ROGER DALE METCALF SR. DDS, JD

MEDICARE: DR. ROGER DALE METCALF SR. DDS, JD
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
1122300000XDentist11514TX

General Provider Information

NPI Number : 1316960446
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROGER DALE METCALF SR. DDS, JD
Provider Business Mailing Address
First Line : 6325 PAPER SHELL WAY
Second Line : PO BOX 137442
City : FORT WORTH
State : TX
Zip : 76136-1442
Country : US
Telephone Number : 817-920-5700
Fax Number :
Provider Business Practice Location Address
First Line : 200 FELIKS GWOZDZ PL
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4919
Country : US
Telephone Number : 817-920-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 04/08/2013

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