MEDICARE: DELBERT LEE KYGER III DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4690	AZ

General Provider Information

NPI Number	:	1013507987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELBERT LEE KYGER III DDS

Provider Business Mailing Address
First Line	:	5406 W GLENN DR STE 5
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2662
Country	:	US
Telephone Number	:	623-931-2351
Fax Number	:

Provider Business Practice Location Address
First Line	:	5406 W GLENN DR STE 5
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2662
Country	:	US
Telephone Number	:	623-931-2351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2021
Last Update Date	:	01/24/2021

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