Provider Demographics
NPI:1538577549
Name:LASTRES, JOANA
Entity type:Individual
Prefix:DR
First Name:JOANA
Middle Name:
Last Name:LASTRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 S.W. HEALTH PARKWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2189
Mailing Address - Country:US
Mailing Address - Phone:239-594-1171
Mailing Address - Fax:
Practice Address - Street 1:5100 S CLEVELAND AVE # 315316
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2189
Practice Address - Country:US
Practice Address - Phone:239-768-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN217621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry