MEDICARE: ARCHUNG & LAGATTA DDS, INC

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

General Provider Information

NPI Number	:	1225509235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCHUNG & LAGATTA DDS, INC

Provider Business Mailing Address
First Line	:	2493 N HIGHWOOD RD
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-6479
Country	:	US
Telephone Number	:	714-343-6114
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 S MAIN ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-1836
Country	:	US
Telephone Number	:	714-343-6114
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN WILLIAM ARCHUNG
Credential	:	DMD
Telephone Number	:	714-343-6114

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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