=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356249684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KYLE LAMBERT DMD // DECATUR FAMILY DENTISTRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2026
-----------------------------------------------------
Last Update Date | 10/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 W DELAWARE ST
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49045-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-423-7025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 W DELAWARE ST
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49045-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-423-7025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | JOE SHIPPEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-472-3839
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------