MEDICARE: DR. CHARLES BRYON HALEY 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	7151	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27440032	OTHER	MO	BCBS
2	388559	OTHER	KS	BCBS

General Provider Information

NPI Number	:	1023089968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES BRYON HALEY DDS

Provider Business Mailing Address
First Line	:	8137 PARALLEL PKWY
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66112
Country	:	US
Telephone Number	:	913-299-8900
Fax Number	:	913-299-2022

Provider Business Practice Location Address
First Line	:	8137 PARALLEL PKWY
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66112
Country	:	US
Telephone Number	:	913-299-8900
Fax Number	:	913-299-2022

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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