Provider Demographics
NPI:1316105398
Name:RICHARD B. LESTAGE, DDS, PLLC
Entity type:Organization
Organization Name:RICHARD B. LESTAGE, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BUTLER
Authorized Official - Last Name:LESTAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-505-3410
Mailing Address - Street 1:99 EDGEWOOD RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3575
Mailing Address - Country:US
Mailing Address - Phone:828-505-3410
Mailing Address - Fax:828-505-3405
Practice Address - Street 1:99 EDGEWOOD RD
Practice Address - Street 2:SUITE E
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3575
Practice Address - Country:US
Practice Address - Phone:828-505-3410
Practice Address - Fax:828-505-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7938261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental