Healthcare Provider Details

I. General information

NPI: 1841344637
Provider Name (Legal Business Name): BARBARA J LESTER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E G ST
ELIZABETHTON TN
37643-3223
US

IV. Provider business mailing address

2506 BEECHWOOD DR
ELIZABETHTON TN
37643-5061
US

V. Phone/Fax

Practice location:
  • Phone: 423-543-2521
  • Fax: 423-543-7348
Mailing address:
  • Phone: 423-543-2521
  • Fax: 423-543-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number3242
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: