Provider Demographics
NPI:1083247480
Name:LESTER DENTAL CORPORATION
Entity Type:Organization
Organization Name:LESTER DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-228-7001
Mailing Address - Street 1:135 KELLER ST STE F
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2312
Mailing Address - Country:US
Mailing Address - Phone:707-778-6006
Mailing Address - Fax:
Practice Address - Street 1:135 KELLER ST STE F
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2312
Practice Address - Country:US
Practice Address - Phone:707-778-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental