Provider Demographics
NPI:1003115031
Name:JOHN L LESNESKI DDS PLC
Entity Type:Organization
Organization Name:JOHN L LESNESKI DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LESNESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-362-6159
Mailing Address - Street 1:P.O. BOX 387
Mailing Address - Street 2:508 W. LAKE STREET
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0387
Mailing Address - Country:US
Mailing Address - Phone:989-362-6159
Mailing Address - Fax:989-362-6798
Practice Address - Street 1:508 W LAKE ST
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-5106
Practice Address - Country:US
Practice Address - Phone:989-362-6159
Practice Address - Fax:989-362-6798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI193321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty