Provider Demographics
NPI:1144773920
Name:LESTINI, LYSANDRA PALMER (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYSANDRA
Middle Name:PALMER
Last Name:LESTINI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 TRESCOTT CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9352
Mailing Address - Country:US
Mailing Address - Phone:919-349-2385
Mailing Address - Fax:
Practice Address - Street 1:11209 TRESCOTT CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-9352
Practice Address - Country:US
Practice Address - Phone:919-349-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice