Provider Demographics
NPI:1225290141
Name:LEMBURG, LUCAS A (DDS)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:A
Last Name:LEMBURG
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 1:2409 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52737-9302
Mailing Address - Country:US
Mailing Address - Phone:319-728-7402
Mailing Address - Fax:319-728-7404
Practice Address - Street 1:2409 SPRING ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS CITY
Practice Address - State:IA
Practice Address - Zip Code:52737-9302
Practice Address - Country:US
Practice Address - Phone:319-728-7402
Practice Address - Fax:319-728-7404
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08541OtherSTATE LIC
IA1255339750Medicaid