Provider Demographics
NPI:1114090545
Name:LEMLEY, WAYNE THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:THOMAS
Last Name:LEMLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-9761
Mailing Address - Country:US
Mailing Address - Phone:509-447-3962
Mailing Address - Fax:
Practice Address - Street 1:424 N WARREN AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9761
Practice Address - Country:US
Practice Address - Phone:509-447-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice