Maite Lestayo, DMD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

DN29212 Issued in FL

Practice address

1120 15TH St
Augusta, GA 30912-0004

Phone

(706) 721-0211

NPI assigned

May 20, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Evans Signature Dentistry LLC

  • General Practice Dentistry
  • Evans, GA
  • NPI 1104443381
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1740029933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1056 TRINITY PL",
            "city": "NORTH AUGUSTA",
            "state": "SC",
            "postal_code": "298608031",
            "telephone_number": "305-763-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 15TH ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004",
            "telephone_number": "706-721-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESTAYO",
        "first_name": "MAITE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "GA",
            "license": "DN123620",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "SC",
            "license": "DGD.10958",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "DN29212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Ann Leslie, M.D.
• Maegan Leslie, PHARMD
• Robert Wayne Leslie, ATC, CSCS
• Tricia Ann Leslie, ATC
• Paul A Lessler, MD
• Amelia Letts
• Christopher Leung
• Nicollette Page Leung, MD
• Christian Leurinda, M.D.
• Bari F Levens, AUD, CCC-A

• Student in an Organized Health Care Education/Training Program in Augusta, GA
• Providers in Augusta, GA by specialty
• Student in an Organized Health Care Education/Training Program in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.