MEDICARE: LESTER C JOERN, JR, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12510	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V12510	OTHER	MO	BCBS - TEXAS
2	15138	OTHER	MO	BCBS - MO
3	519832	OTHER	MO	WITH UNITED CONCORDIA
4	014487	OTHER	MO	AETNA DMO
5	103333	OTHER	MO	CIGNA DHMO
6	CBAR1	OTHER	MO	BCBS - ARKANSAS

General Provider Information

NPI Number	:	1720075005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESTER C JOERN, JR, DDS, PC

Provider Business Mailing Address
First Line	:	6451 CHIPPEWA ST
Second Line	:	SUITE A
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2104
Country	:	US
Telephone Number	:	314-752-7468
Fax Number	:	314-752-5168

Provider Business Practice Location Address
First Line	:	6451 CHIPPEWA ST
Second Line	:	SUITE A
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2104
Country	:	US
Telephone Number	:	314-752-7468
Fax Number	:	314-752-5168

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LESTER C JOERN JR.
Credential	:	DDS
Telephone Number	:	314-752-7468

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	08/22/2020

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