MEDICARE: DR. BILLY DALE TURLEY D.M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	61365	KS
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2016021775	MO

General Provider Information

NPI Number	:	1962692624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BILLY DALE TURLEY D.M.D.

Provider Business Mailing Address
First Line	:	2801 W 112TH ST
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66211-2952
Country	:	US
Telephone Number	:	502-802-0389
Fax Number	:

Provider Business Practice Location Address
First Line	:	BELTON MODERN DENTISTRY
Second Line	:	1731 E. NORTH AVE
City	:	BELTON
State	:	MO
Zip	:	64012
Country	:	US
Telephone Number	:	816-322-3506
Fax Number	:

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	09/13/2021

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