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General NPI Number Information
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NPI Number | 1336594449
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Entity Type | Organization
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Legal Business Name | LESMEISTER DENTAL LLC
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 1726 UNIVERSITY AVE
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City | CROOKSTON
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State | MN
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Zip | 56716
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Country | US
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Telephone | 218-281-4323
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Fax | 218-281-1722
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Provider Business Mailing Address
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Address Line | 1726 UNIVERSITY AVE PO BOX 498
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City | CROOKSTON
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State | MN
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Zip | 56716
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Country | US
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Telephone | 218-281-4323
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Fax | 218-281-1722
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Authorized Official
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Title or Position | BOOKKEEPING
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Name | JOANNA D NESVOLD
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Credential |
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Telephone | 218-281-4323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12845
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License Number State | MN
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