Healthcare Provider Details

I. General information

NPI: 1588084537
Provider Name (Legal Business Name): RYAN LEMKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 06/25/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 N 45TH ST
SEATTLE WA
98103-6702
US

IV. Provider business mailing address

1628 N 45TH ST
SEATTLE WA
98103-6702
US

V. Phone/Fax

Practice location:
  • Phone: 206-632-3638
  • Fax: 206-632-3638
Mailing address:
  • Phone: 206-856-5126
  • Fax: 206-632-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60634484
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60634484
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: