Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4690 | AZ |
NPI | 1013507987 |
---|---|
Provider Name | Delbert Lee Kyger III |
First Address | Glendale, AZ 85301-2662 |
Second Address | Glendale, AZ 85301-2662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2021 |
Last Update Date | 24/01/2021 |