Provider Demographics
NPI:1679290258
Name:KEITH METZGER, DDS, PC
Entity Type:Organization
Organization Name:KEITH METZGER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:1213 HALL JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5896
Mailing Address - Country:US
Mailing Address - Phone:817-428-1800
Mailing Address - Fax:
Practice Address - Street 1:1213 HALL JOHNSON RD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5896
Practice Address - Country:US
Practice Address - Phone:817-428-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty