MEDICARE: LUCAS A LEMBURG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	08541	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08541	OTHER	IA	STATE LIC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225290141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS A LEMBURG DDS

Provider Business Mailing Address
First Line	:	2409 SPRING ST
Second Line	:
City	:	COLUMBUS CITY
State	:	IA
Zip	:	52737-9302
Country	:	US
Telephone Number	:	319-728-7402
Fax Number	:	319-728-7404

Provider Business Practice Location Address
First Line	:	2409 SPRING ST
Second Line	:
City	:	COLUMBUS CITY
State	:	IA
Zip	:	52737-9302
Country	:	US
Telephone Number	:	319-728-7402
Fax Number	:	319-728-7404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	01/14/2011

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