Provider Demographics
NPI:1275610834
Name:JAMES DALE LESTER DMD PSC
Entity Type:Organization
Organization Name:JAMES DALE LESTER DMD PSC
Other - Org Name:PROFFESIONAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PSC
Authorized Official - Phone:606-638-4445
Mailing Address - Street 1:405 E PERRY STREET
Mailing Address - Street 2:PO BOX 156
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230
Mailing Address - Country:US
Mailing Address - Phone:606-638-4445
Mailing Address - Fax:606-638-4446
Practice Address - Street 1:405 E PERRY STREET
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230
Practice Address - Country:US
Practice Address - Phone:606-638-4445
Practice Address - Fax:606-638-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60055894Medicaid