Provider Demographics
NPI:1700973641
Name:LESTER, STEPHEN P (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:LESTER
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-1710
Mailing Address - Country:US
Mailing Address - Phone:386-423-7770
Mailing Address - Fax:386-423-6638
Practice Address - Street 1:104 E PARK AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-1710
Practice Address - Country:US
Practice Address - Phone:386-423-7770
Practice Address - Fax:386-423-6638
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN60421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice