MEDICARE: DR. RYAN LEMKE 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	1223G0001X	General Practice Dentistry	60634484	WA
2	122300000X	Dentist	60634484	WA

General Provider Information

NPI Number	:	1588084537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN LEMKE DDS

Provider Business Mailing Address
First Line	:	1628 N 45TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6702
Country	:	US
Telephone Number	:	206-856-5126
Fax Number	:	206-632-3638

Provider Business Practice Location Address
First Line	:	1628 N 45TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6702
Country	:	US
Telephone Number	:	206-632-3638
Fax Number	:	206-632-3638

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

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	06/25/2021

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