Provider Demographics
NPI:1891938767
Name:FERMBACK, LENA B (DDS)
Entity Type:Individual
Prefix:DR
First Name:LENA
Middle Name:B
Last Name:FERMBACK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-4706
Mailing Address - Country:US
Mailing Address - Phone:574-267-3040
Mailing Address - Fax:574-268-2530
Practice Address - Street 1:1010 S UNION ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4706
Practice Address - Country:US
Practice Address - Phone:574-267-3040
Practice Address - Fax:574-268-2530
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN128008691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist