Provider Demographics
NPI:1164163937
Name:LENA, UMME
Entity Type:Individual
Prefix:
First Name:UMME
Middle Name:
Last Name:LENA
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 1:1 GREYROCK PL APT 4163
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3162
Mailing Address - Country:US
Mailing Address - Phone:646-642-2150
Mailing Address - Fax:
Practice Address - Street 1:105-107 THEODORE FREMOND AVE
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580
Practice Address - Country:US
Practice Address - Phone:914-967-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist