Healthcare Provider Details

I. General information

NPI: 1740342682
Provider Name (Legal Business Name): KEVIN CHAD LAMBOURNE DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 S 32ND ST W SUITE A
BILLINGS MT
59102-6875
US

IV. Provider business mailing address

152 S 32ND ST W SUITE A
BILLINGS MT
59102-6875
US

V. Phone/Fax

Practice location:
  • Phone: 406-245-4414
  • Fax: 406-294-4416
Mailing address:
  • Phone: 406-245-4414
  • Fax: 406-294-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6377376-9921
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number050699
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD-3940-OR
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2356
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1395
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: