# BEAR RIVER DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Nathan R. Lester DMD PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649575465
- **Authorized official:** NATHAN R LESTER DMD (OWNER)
- **Authorized official phone:** (307) 789-5608

## Contact information

- **Practice address:** 50 PARK RD, EVANSTON, WY 82930-2613
- **Practice address phone:** (307) 789-5608
- **Practice address fax:** (307) 789-4401
- **Mailing address:** 50 PARK RD, EVANSTON, WY 82930-2613
- **Mailing address phone:** (307) 789-5608
- **Mailing address fax:** (307) 789-4401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 1131 | WY | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 1250 | WY | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 1257 | WY | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | 1202 | WY | — |

## Other

- **Enumeration date:** 01/26/2011
- **Last updated:** 01/26/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1023268299 | — | WY |
| 05 | — | 1063492981 | — | WY |
| 05 | — | 1558432120 | — | WY |
| 05 | — | 1689795114 | — | WY |