Provider Demographics
NPI:1124869607
Name:LEMBKE, RYAN BRADLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BRADLEY
Last Name:LEMBKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1877
Mailing Address - Country:US
Mailing Address - Phone:612-710-6453
Mailing Address - Fax:
Practice Address - Street 1:5831 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2521
Practice Address - Country:US
Practice Address - Phone:763-533-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND150641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice