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NPI Code Detail

MEDICARE: DR. BILLY JASON KYLES D.D.S.

MEDICARE: DR. BILLY JASON KYLES D.D.S.
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
11223G0001XGeneral Practice Dentistry3362AR
21223P0106XOral and Maxillofacial Pathology Dentistry060784NY
3122300000XDentistDN013833GA

General Provider Information

NPI Number : 1205831633
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BILLY JASON KYLES D.D.S.
Provider Business Mailing Address
First Line : 345 E 24TH ST # 2S
Second Line :
City : NEW YORK
State : NY
Zip : 10010-4020
Country : US
Telephone Number : 212-998-9743
Fax Number : 212-995-4767
Provider Business Practice Location Address
First Line : 345 E 24TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10010-4020
Country : US
Telephone Number : 212-998-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 05/13/2026

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