Provider Demographics
NPI:1548482979
Name:GRANT A. LEMKE D.D.S., S.C.
Entity type:Organization
Organization Name:GRANT A. LEMKE D.D.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-367-4245
Mailing Address - Street 1:510 HARTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1440
Mailing Address - Country:US
Mailing Address - Phone:262-367-4245
Mailing Address - Fax:262-367-6537
Practice Address - Street 1:510 HARTBROOK DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1440
Practice Address - Country:US
Practice Address - Phone:262-367-4245
Practice Address - Fax:262-367-6537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty