MAITE LESTAYO

AUGUSTA, GA
NPI1740029933
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
(Licence: FL  DN29212)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
(Licence: GA  DN123620)
390200000X Student in an Organized Health Care Education/Training Program
(Licence: SC  DGD.10958)
Enumeration Date2024-05-20
Last Update Date2024-10-10
Business Address
MAITE LESTAYO DMD
1120 15TH ST
AUGUSTA, GA 30912-0004
Phone number: 706-721-0211
Mailing Address
MAITE LESTAYO DMD
1056 TRINITY PL
NORTH AUGUSTA, SC 29860-8031
Phone number: 305-763-1404