Provider Demographics
NPI:1366865081
Name:ROBERT R. LEMKE DDS, MD, PA
Entity Type:Organization
Organization Name:ROBERT R. LEMKE DDS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD, PA
Authorized Official - Phone:210-491-0015
Mailing Address - Street 1:14500 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4391
Mailing Address - Country:US
Mailing Address - Phone:210-491-0015
Mailing Address - Fax:210-491-0352
Practice Address - Street 1:14500 SAN PEDRO AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4391
Practice Address - Country:US
Practice Address - Phone:210-491-0015
Practice Address - Fax:210-491-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287481223P0300X
TX153421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty