Provider Demographics
NPI:1275928251
Name:JEFF LEMON DMD
Entity Type:Organization
Organization Name:JEFF LEMON DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-943-5639
Mailing Address - Street 1:108 22 ND AVE SW
Mailing Address - Street 2:SUITE 12
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501
Mailing Address - Country:UM
Mailing Address - Phone:360-943-5639
Mailing Address - Fax:360-753-3525
Practice Address - Street 1:108 22ND AVE SW
Practice Address - Street 2:SUITE 12
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2871
Practice Address - Country:US
Practice Address - Phone:360-943-5639
Practice Address - Fax:360-756-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601978529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========Medicaid