Provider Demographics
NPI:1629675244
Name:LEMMO, MADISON (DMD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:LEMMO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PEMBERTON RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-4817
Mailing Address - Country:US
Mailing Address - Phone:508-380-3671
Mailing Address - Fax:
Practice Address - Street 1:29 HUDSON RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1757
Practice Address - Country:US
Practice Address - Phone:978-443-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18588171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice