Provider Demographics
NPI:1760586853
Name:PETERSON, LESTER ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:ROY
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14605 SE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1669
Mailing Address - Country:US
Mailing Address - Phone:425-643-3912
Mailing Address - Fax:425-643-7988
Practice Address - Street 1:14605 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1669
Practice Address - Country:US
Practice Address - Phone:425-643-3912
Practice Address - Fax:425-643-7988
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA53111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice