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General NPI Number Information
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NPI Number | 1083247480
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Entity Type | Organization
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Legal Business Name | LESTER DENTAL CORPORATION
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 135 KELLER ST STE F
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City | PETALUMA
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State | CA
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Zip | 94952-2312
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Country | US
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Telephone | 707-778-6006
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Fax |
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Provider Business Mailing Address
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Address Line | 135 KELLER ST STE F
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City | PETALUMA
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State | CA
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Zip | 94952-2312
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Country | US
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Telephone | 707-778-6006
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | DR. ANASTASIA LESTER
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Credential | DDS
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Telephone | 707-228-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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