Provider Demographics
NPI:1558432120
Name:LESTER, NATHAN REN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:REN
Last Name:LESTER
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 1:50 PARK RD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-2613
Mailing Address - Country:US
Mailing Address - Phone:307-789-5608
Mailing Address - Fax:307-789-4401
Practice Address - Street 1:50 PARK RD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-2613
Practice Address - Country:US
Practice Address - Phone:307-789-5608
Practice Address - Fax:307-789-4401
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121276100Medicaid