MEDICARE: BRIAN C LEY DDS, PC

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	7976	CO
2	122300000X	Dentist	10642	AZ

General Provider Information

NPI Number	:	1760511893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN C LEY DDS, PC

Provider Business Mailing Address
First Line	:	1751 W ORANGE GROVE RD BLDG 2
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1193
Country	:	US
Telephone Number	:	520-797-8030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 W ORANGE GROVE RD BLDG 2
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1193
Country	:	US
Telephone Number	:	520-797-8030
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	06/18/2024

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