MEDICARE: TIMOTHY P. REARDON D.D.S., M.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	64270	NV

General Provider Information

NPI Number	:	1023158375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY P. REARDON D.D.S., M.S.

Provider Business Mailing Address
First Line	:	8490 S EASTERN AVE STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2806
Country	:	US
Telephone Number	:	702-260-8241
Fax Number	:	702-260-8251

Provider Business Practice Location Address
First Line	:	8490 S EASTERN AVE STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2806
Country	:	US
Telephone Number	:	702-260-8241
Fax Number	:	702-260-8251

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIMOTHY P. REARDON
Credential	:	D.D.S., M.S.
Telephone Number	:	702-260-8241

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

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