MEDICARE: DR. BILLY J HA 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	1223G0001X	General Practice Dentistry	59636	CA

General Provider Information

NPI Number	:	1609191394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BILLY J HA DDS

Provider Business Mailing Address
First Line	:	6900 NORTH PECOS ROAD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89036-6602
Country	:	US
Telephone Number	:	702-791-9019
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 NORTH PECOS ROAD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89036-6602
Country	:	US
Telephone Number	:	702-791-9019
Fax Number	:

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

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	03/12/2013

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