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Organization
THE DENTAL IMPLANT SOURCE
Active
Organization
THE DENTAL IMPLANT SOURCE
Active
Other names
Cheyenne Advanced Dental Arts
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYLE SCOTT BROOKSBY DDS (PRESIDENT)
(702) 367-4121
Entity
Organization
Contact information
Practice address
8960 W CHEYENNE AVE UNIT 190, LAS VEGAS, NV 89129-8929
(702) 367-4121
(702) 367-4021
Mailing address
8960 W CHEYENNE AVE UNIT 190, LAS VEGAS, NV 89129-8929
(702) 367-4121
(702) 367-4021
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
2543
NV
Other
Enumeration date
02/21/2007
Last updated
08/22/2020
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