# JON DOUGLAS LESAN DDS RPH PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952479156
- **Authorized official:** DR. JON DOUGLAS LESAN DDS RPH PA (OWNER DENTIST)
- **Authorized official phone:** (910) 347-1211

## Contact information

- **Practice address:** 123 COBIA CT, JACKSONVILLE, NC 28546-6862
- **Practice address phone:** (910) 347-1211
- **Practice address fax:** (910) 347-0765
- **Mailing address:** 123 COBIA CT, JACKSONVILLE, NC 28546-6862
- **Mailing address phone:** (910) 347-1211
- **Mailing address fax:** (910) 347-0765

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NC | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 12/04/2006
- **Last updated:** 03/07/2023