Provider Demographics
NPI:1922191204
Name:LESTER, LISA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:LESTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 UTICA ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1528
Mailing Address - Country:US
Mailing Address - Phone:315-853-6181
Mailing Address - Fax:315-859-1038
Practice Address - Street 1:46 UTICA ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1528
Practice Address - Country:US
Practice Address - Phone:315-853-6181
Practice Address - Fax:315-859-1038
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0470981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02207601Medicaid