Provider Demographics
NPI:1790669570
Name:LEMON, CONRAD JORDAN (DMD)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:JORDAN
Last Name:LEMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8204 DELTA SHORES CIR S STE 140
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95832-9111
Mailing Address - Country:US
Mailing Address - Phone:916-277-9069
Mailing Address - Fax:
Practice Address - Street 1:8204 DELTA SHORES CIR S STE 140
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95832-9111
Practice Address - Country:US
Practice Address - Phone:916-277-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist