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General NPI Number Information
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NPI Number | 1356613681
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Entity Type | Organization
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Legal Business Name | C.M. LESTER DDS A PROFESSIONAL DENTAL CORP
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 4034 HOLLYWOOD AVE
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City | SHREVEPORT
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State | LA
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Zip | 71109-7938
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Country | US
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Telephone | 318-631-0270
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Fax | 318-631-0233
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Provider Business Mailing Address
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Address Line | 4034 HOLLYWOOD AVE
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City | SHREVEPORT
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State | LA
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Zip | 71109-7938
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Country | US
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Telephone | 318-631-0270
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Fax | 318-631-0233
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLEY MARION LESTER JR.
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Credential | D.D.S.
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Telephone | 318-631-0270
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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 | 1956
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License Number State | LA
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