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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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