MEDICARE: BRIAN WILLIAM ARCHUNG DDS

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	122300000X	Dentist	37047	TX
2	1223G0001X	General Practice Dentistry	47227	CA
3	1223G0001X	General Practice Dentistry	37047	TX

General Provider Information

NPI Number	:	1134260888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN WILLIAM ARCHUNG DDS

Provider Business Mailing Address
First Line	:	1380 EL SOBRANTE RD
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-5759
Country	:	US
Telephone Number	:	951-273-9580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 EL SOBRANTE RD
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-5759
Country	:	US
Telephone Number	:	951-273-9580
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	03/26/2021

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