Healthcare Provider Details

I. General information

NPI: 1225457633
Provider Name (Legal Business Name): KAYLA LAMMERT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PROVIDENCE DR
WACO TX
76707-2261
US

IV. Provider business mailing address

13001 E 17TH PL
AURORA CO
80045-2570
US

V. Phone/Fax

Practice location:
  • Phone: 254-313-4200
  • Fax: 254-313-4549
Mailing address:
  • Phone: 303-724-6996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30005
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: