Provider Demographics
NPI:1154404879
Name:JOERN, LESTER C JR (DDS)
Entity type:Individual
Prefix:DR
First Name:LESTER
Middle Name:C
Last Name:JOERN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6451 CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2104
Mailing Address - Country:US
Mailing Address - Phone:314-752-7468
Mailing Address - Fax:314-752-5168
Practice Address - Street 1:6451 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2104
Practice Address - Country:US
Practice Address - Phone:314-752-7468
Practice Address - Fax:314-752-5168
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO125101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
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MO060020OtherFIRST COMMONWEALTH HMO
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MOV12510OtherBCBS - TEXAS
MO014487OtherAETNA DMO
MO103338OtherCIGNA DHMO
MO519832OtherUNITED CONCORDIA
MO15138OtherBCBS-MISSOURI
MOCBAR1OtherBCBS-ARKANSAS
MO470104OtherCOMPBENEFITS HMO