MEDICARE: DR. MICHAEL BILLINGSLEY 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	104763	CO
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN013698	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730255522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BILLINGSLEY DDS

Provider Business Mailing Address
First Line	:	2420 GREEN MOUNTAIN DR
Second Line	:
City	:	BRASELTON
State	:	GA
Zip	:	30517-7015
Country	:	US
Telephone Number	:	719-439-4968
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 GREEN MOUNTAIN DR
Second Line	:
City	:	BRASELTON
State	:	GA
Zip	:	30517-7015
Country	:	US
Telephone Number	:	719-439-4968
Fax Number	:

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	10/28/2010

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