Provider Demographics
NPI:1366453417
Name:LEMKE, TIMOTHY RUSSELL (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RUSSELL
Last Name:LEMKE
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 1:13701 EAST MISSISSIPPI AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012
Mailing Address - Country:US
Mailing Address - Phone:303-366-1592
Mailing Address - Fax:303-366-1812
Practice Address - Street 1:13701 EAST MISSISSIPPI AVE
Practice Address - Street 2:STE 310
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012
Practice Address - Country:US
Practice Address - Phone:303-366-1592
Practice Address - Fax:303-366-1812
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO55551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice