Provider Demographics
NPI:1235252560
Name:JESTER, LYNN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:A
Last Name:JESTER
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 1:9112 LEESGATE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5054
Mailing Address - Country:US
Mailing Address - Phone:502-426-5267
Mailing Address - Fax:502-426-5975
Practice Address - Street 1:9112 LEESGATE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5054
Practice Address - Country:US
Practice Address - Phone:502-426-5267
Practice Address - Fax:502-426-5975
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist