Provider Demographics
NPI:1639837073
Name:LEMOS DENTAL CORPORATION
Entity Type:Organization
Organization Name:LEMOS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-435-9616
Mailing Address - Street 1:1022 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3279
Mailing Address - Country:US
Mailing Address - Phone:909-435-9616
Mailing Address - Fax:909-363-9555
Practice Address - Street 1:1022 ORANGE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3279
Practice Address - Country:US
Practice Address - Phone:909-435-9616
Practice Address - Fax:909-363-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental