Organization
C.M. LESTER DDS A PROFESSIONAL DENTAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLEY MARION LESTER JR. D.D.S. (PRESIDENT)
(318) 631-0270
Entity
Organization
Contact information
Practice address
4034 HOLLYWOOD AVE, SHREVEPORT, LA 71109-7938
(318) 631-0270
(318) 631-0233
Mailing address
4034 HOLLYWOOD AVE, SHREVEPORT, LA 71109-7938
(318) 631-0270
(318) 631-0233
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
1956
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1819565
—
LA
Enumeration date
02/02/2012
Last updated
02/02/2012
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