Provider Demographics
NPI:1285939322
Name:GRANGER, LEKEBA TIER (DMD)
Entity type:Individual
Prefix:
First Name:LEKEBA
Middle Name:TIER
Last Name:GRANGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 TOWN CENTER DR APT 3801
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-7305
Mailing Address - Country:US
Mailing Address - Phone:309-989-7320
Mailing Address - Fax:
Practice Address - Street 1:1553 FM 685 STE 400
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3686
Practice Address - Country:US
Practice Address - Phone:512-989-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190285481223G0001X
TX32403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice