1720075005 NPI number — LESTER C JOERN, JR, DDS, PC

Table of content: (NPI 1720075005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720075005 NPI number — LESTER C JOERN, JR, DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LESTER C JOERN, JR, DDS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720075005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6451 CHIPPEWA ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63109-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-752-7468
Provider Business Practice Location Address Fax Number:
314-752-5168
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOERN
Authorized Official First Name:
LESTER
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-752-7468

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12510 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: V12510 . This is a "BCBS - TEXAS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 15138 . This is a "BCBS - MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 519832 . This is a "WITH UNITED CONCORDIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 014487 . This is a "AETNA DMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 103333 . This is a "CIGNA DHMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CBAR1 . This is a "BCBS - ARKANSAS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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