=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952190324
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRYON HALEY DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2025
-----------------------------------------------------
Last Update Date | 05/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 HUTTON RD STE 102
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66109-4424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-721-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 HUTTON RD STE 102
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66109-4424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-721-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHARLES BRYON HALEY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 913-721-3400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------