Individual
DR. ROGER DALE KILCOYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
364 GARLAND ST, MEMPHIS, TN 38104-7129
(901) 574-2402
Mailing address
364 GARLAND ST, MEMPHIS, TN 38104-7129
(901) 574-2402
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
10159
CO
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/30/2010
Last updated
05/03/2010
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