Provider Demographics
NPI:1881866549
Name:QUALK, LESTER FRANKLIN JR (DMD)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:FRANKLIN
Last Name:QUALK
Suffix:JR
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 1:357 REGIS AVE
Mailing Address - Street 2:SUITE2
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-1451
Mailing Address - Country:US
Mailing Address - Phone:412-655-4114
Mailing Address - Fax:412-655-4158
Practice Address - Street 1:357 REGIS AVE
Practice Address - Street 2:SUITE2
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-1451
Practice Address - Country:US
Practice Address - Phone:412-655-4114
Practice Address - Fax:412-655-4158
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022918-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA916690Medicaid