MEDICARE: TAYLOR FALLON

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	124Q00000X	Dental Hygienist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	XBP850158312	OTHER	AZ	BLUE CROSS BLUE SHIELD OF ARIZONA

General Provider Information

NPI Number	:	1184290694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR FALLON

Provider Business Mailing Address
First Line	:	4200 E RIVER RD UNIT A
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6933
Country	:	US
Telephone Number	:	520-999-0772
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 E RIVER RD UNIT A
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6933
Country	:	US
Telephone Number	:	520-999-0772
Fax Number	:

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	06/03/2021

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Directions to “ TAYLOR FALLON ” Practice Location

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