Provider Demographics
NPI:1790187698
Name:KYLE LAMBERT D.M.D. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KYLE LAMBERT D.M.D. PROFESSIONAL CORPORATION
Other - Org Name:LASALLE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:307-287-0729
Mailing Address - Street 1:202 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:CO
Mailing Address - Zip Code:80645-3306
Mailing Address - Country:US
Mailing Address - Phone:970-284-7930
Mailing Address - Fax:970-284-6635
Practice Address - Street 1:202 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:CO
Practice Address - Zip Code:80645-3306
Practice Address - Country:US
Practice Address - Phone:970-284-7930
Practice Address - Fax:970-284-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty