Provider Demographics
NPI:1033104187
Name:LEMARR, GARY M (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:LEMARR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276-1441
Mailing Address - Country:US
Mailing Address - Phone:208-547-2244
Mailing Address - Fax:208-547-0375
Practice Address - Street 1:180 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276-1441
Practice Address - Country:US
Practice Address - Phone:208-547-2244
Practice Address - Fax:208-547-0375
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
IDD17851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice