Provider Demographics
NPI:1295180313
Name:LESMEISTER DENTAL LLC
Entity Type:Organization
Organization Name:LESMEISTER DENTAL LLC
Other - Org Name:LESMEISTER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NESVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-253-4204
Mailing Address - Street 1:105 INTERNATIONAL DRIVE, SUITE 110
Mailing Address - Street 2:PO BOX 236
Mailing Address - City:RED LAKE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56750-0236
Mailing Address - Country:US
Mailing Address - Phone:218-256-4204
Mailing Address - Fax:218-253-4205
Practice Address - Street 1:105 INTERNATIONAL DRIVE, SUITE 110
Practice Address - Street 2:
Practice Address - City:RED LAKE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56750-0236
Practice Address - Country:US
Practice Address - Phone:218-256-4204
Practice Address - Fax:218-253-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND128451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty