Provider Demographics
NPI:1013507987
Name:KYGER, DELBERT LEE III (DDS)
Entity type:Individual
Prefix:
First Name:DELBERT
Middle Name:LEE
Last Name:KYGER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 W GLENN DR STE 5
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-2662
Mailing Address - Country:US
Mailing Address - Phone:623-931-2351
Mailing Address - Fax:
Practice Address - Street 1:5406 W GLENN DR STE 5
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2662
Practice Address - Country:US
Practice Address - Phone:623-931-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty