Healthcare Provider Details

I. General information

NPI: 1053058651
Provider Name (Legal Business Name): KYLE LAMBERT DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3749 N DIXIE HWY
MONROE MI
48162-4489
US

IV. Provider business mailing address

3749 N DIXIE HWY
MONROE MI
48162-4489
US

V. Phone/Fax

Practice location:
  • Phone: 307-287-0729
  • Fax:
Mailing address:
  • Phone: 307-287-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE LAMBERT
Title or Position: OWNER
Credential: DMD
Phone: 307-287-0729