MEDICARE: DR. JERRID F TURLEY 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	122300000X	Dentist	30866	CA

General Provider Information

NPI Number	:	1285981936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRID F TURLEY DDS

Provider Business Mailing Address
First Line	:	2223 BEECH KNOLL RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-1519
Country	:	US
Telephone Number	:	323-650-5769
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 BEECH KNOLL RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-1519
Country	:	US
Telephone Number	:	323-650-5769
Fax Number	:

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

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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