Individual
TAYLOR FALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4200 E RIVER RD UNIT A, TUCSON, AZ 85718-6933
(520) 999-0772
Mailing address
4200 E RIVER RD UNIT A, TUCSON, AZ 85718-6933
(520) 999-0772
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XBP850158312
BLUE CROSS BLUE SHIELD OF ARIZONA
AZ
Enumeration date
06/03/2021
Last updated
06/03/2021
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