Provider Demographics
NPI:1659835643
Name:LESTER, ANASTASIA (DDS)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:LESTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:POGADAJEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:401 KENILWORTH DR STE 960
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3406
Mailing Address - Country:US
Mailing Address - Phone:707-789-9600
Mailing Address - Fax:
Practice Address - Street 1:401 KENILWORTH DR STE 960
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3406
Practice Address - Country:US
Practice Address - Phone:707-789-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1034901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice