Provider Demographics
NPI:1316697808
Name:LEMAIRE, DJENANE
Entity type:Individual
Prefix:
First Name:DJENANE
Middle Name:
Last Name:LEMAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CITYGREEN WAY APT 305
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1490
Mailing Address - Country:US
Mailing Address - Phone:917-208-5257
Mailing Address - Fax:
Practice Address - Street 1:42 MARKET SQUARE RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5701
Practice Address - Country:US
Practice Address - Phone:770-251-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12066122300000X
GADN122836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist