# THE DENTAL IMPLANT SOURCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cheyenne Advanced Dental Arts
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457496077
- **Authorized official:** DR. LYLE SCOTT BROOKSBY DDS (PRESIDENT)
- **Authorized official phone:** (702) 367-4121

## Contact information

- **Practice address:** 8960 W CHEYENNE AVE UNIT 190, LAS VEGAS, NV 89129-8929
- **Practice address phone:** (702) 367-4121
- **Practice address fax:** (702) 367-4021
- **Mailing address:** 8960 W CHEYENNE AVE UNIT 190, LAS VEGAS, NV 89129-8929
- **Mailing address phone:** (702) 367-4121
- **Mailing address fax:** (702) 367-4021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | 2543 | NV | Yes |

## Other

- **Enumeration date:** 02/21/2007
- **Last updated:** 08/22/2020