Provider Demographics
NPI:1245765668
Name:LEMON, CHRISTINE ANTONIO (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANTONIO
Last Name:LEMON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8980 VIA VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6535
Mailing Address - Country:US
Mailing Address - Phone:702-501-2687
Mailing Address - Fax:
Practice Address - Street 1:14100 N 83RD AVE STE 280
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5660
Practice Address - Country:US
Practice Address - Phone:602-820-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD0106961223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program