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1740029933
MAITE LESTAYO
AUGUSTA, GA
NPI
1740029933
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: FL DN29212)
Enumeration Date
2024-05-20
Last Update Date
2024-09-20
Business Address
MAITE LESTAYO DMD
1120 15TH ST
AUGUSTA, GA 30912-0004
Phone number: 706-721-0211
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Mailing Address
MAITE LESTAYO DMD
1056 TRINITY PL
NORTH AUGUSTA, SC 29860-8031
Phone number: 305-763-1404
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