MEDICARE: TUCSON SPECTRUM DENTISTRY, LLP

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

General Provider Information

NPI Number	:	1336547306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUCSON SPECTRUM DENTISTRY, LLP

Provider Business Mailing Address
First Line	:	17000 RED HILL AVENUE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	5369 S CALLE SANTA CRUZ STE 105
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-3963
Country	:	US
Telephone Number	:	520-889-3379
Fax Number	:	520-889-3380

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. DARIN S REAGAN
Credential	:	DDS
Telephone Number	:	520-889-3379

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	12/16/2014

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