Provider Demographics
NPI:1982613733
Name:KARKALAS, LENA DIANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LENA
Middle Name:DIANE
Last Name:KARKALAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LENA
Other - Middle Name:DIANE
Other - Last Name:BERWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:151 WATERMAN ST
Mailing Address - Street 2:UNIT #3
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2118
Mailing Address - Country:US
Mailing Address - Phone:401-861-2140
Mailing Address - Fax:401-861-3010
Practice Address - Street 1:151 WATERMAN ST
Practice Address - Street 2:UNIT #3
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2118
Practice Address - Country:US
Practice Address - Phone:401-861-2140
Practice Address - Fax:401-861-3010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI026781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice