Healthcare Provider Details

I. General information

NPI: 1417443276
Provider Name (Legal Business Name): KYLE THOMAS LANTZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W EISENHOWER BLVD
LOVELAND CO
80537-3106
US

IV. Provider business mailing address

3744 S TIMBERLINE RD STE 101
FORT COLLINS CO
80525-4334
US

V. Phone/Fax

Practice location:
  • Phone: 970-232-3750
  • Fax:
Mailing address:
  • Phone: 970-229-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4933
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDRPM2601
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number00206279
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: