Healthcare Provider Details

I. General information

NPI: 1225290141
Provider Name (Legal Business Name): LUCAS A LEMBURG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 SPRING ST
COLUMBUS CITY IA
52737-9302
US

IV. Provider business mailing address

2409 SPRING ST
COLUMBUS CITY IA
52737-9302
US

V. Phone/Fax

Practice location:
  • Phone: 319-728-7402
  • Fax: 319-728-7404
Mailing address:
  • Phone: 319-728-7402
  • Fax: 319-728-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number08541
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: