Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN013833 | GA |
Y | 1223G0001X | General Practice | 3362 | AR |
Y | 213EG0000X | General Practice | 3362 | AR |
N | 1223P0106X | Oral and Maxillofacial Pathology | 060784 | NY |
NPI | 1205831633 |
---|---|
Provider Name | Dr. Billy Jason Kyles |
First Address | Astoria, NY 11103-5136 |
Second Address | New York, NY 10010-4020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 23/09/2019 |