Provider Demographics
NPI:1720075005
Name:LESTER C JOERN, JR, DDS, PC
Entity Type:Organization
Organization Name:LESTER C JOERN, JR, DDS, PC
Other - Org Name:SOUTH ST. LOUIS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOERN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-752-7468
Mailing Address - Street 1:6451 CHIPPEWA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2104
Mailing Address - Country:US
Mailing Address - Phone:314-752-7468
Mailing Address - Fax:314-752-5168
Practice Address - Street 1:6451 CHIPPEWA ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2104
Practice Address - Country:US
Practice Address - Phone:314-752-7468
Practice Address - Fax:314-752-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO125101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV12510OtherBCBS - TEXAS
MO15138OtherBCBS - MO
MO519832OtherWITH UNITED CONCORDIA
MO014487OtherAETNA DMO
MO103333OtherCIGNA DHMO
MOCBAR1OtherBCBS - ARKANSAS