MEDICARE: LISA A. LEAR, DDS, MSD, 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	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1225455637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA A. LEAR, DDS, MSD, PC

Provider Business Mailing Address
First Line	:	6367 E TANQUE VERDE RD
Second Line	:	SUITE 210
City	:	TUCSON
State	:	AZ
Zip	:	85715-3829
Country	:	US
Telephone Number	:	520-577-3935
Fax Number	:

Provider Business Practice Location Address
First Line	:	6367 E TANQUE VERDE RD
Second Line	:	SUITE 210
City	:	TUCSON
State	:	AZ
Zip	:	85715-3829
Country	:	US
Telephone Number	:	520-577-3935
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LISA A. LEAR
Credential	:	DDS, MSD
Telephone Number	:	520-577-3938

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	03/24/2014

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