Provider Demographics
NPI:1376636746
Name:LEMKE, GRANT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:A
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 1:3079 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-8361
Mailing Address - Country:US
Mailing Address - Phone:262-367-4245
Mailing Address - Fax:262-367-6537
Practice Address - Street 1:3079 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-8361
Practice Address - Country:US
Practice Address - Phone:262-367-4245
Practice Address - Fax:262-367-6537
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice