Provider Demographics
NPI:1831107945
Name:RICHINS, LESTER ALBERT (DMD)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:ALBERT
Last Name:RICHINS
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 1:100 W OVERLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3052
Mailing Address - Country:US
Mailing Address - Phone:208-884-0888
Mailing Address - Fax:208-895-8533
Practice Address - Street 1:100 W OVERLAND RD STE A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3052
Practice Address - Country:US
Practice Address - Phone:208-884-0888
Practice Address - Fax:208-895-8533
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD31861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID6F126OtherBLUE CROSS OF IDAHO