Provider Demographics
NPI:1043431505
Name:PERIODONTAL HEALTH SPECIALISTS
Entity Type:Organization
Organization Name:PERIODONTAL HEALTH SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:585-473-7600
Mailing Address - Street 1:1815 S CLINTON AVENUE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-473-7600
Mailing Address - Fax:585-473-7653
Practice Address - Street 1:1815 S CLINTON AVENUE
Practice Address - Street 2:SUITE 510
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-473-7600
Practice Address - Fax:585-473-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty