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 1:230 EAST AVE APT C426
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-1979
Mailing Address - Country:US
Mailing Address - Phone:646-642-2150
Mailing Address - Fax:
Practice Address - Street 1:839 RIVER RD STE A
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-5433
Practice Address - Country:US
Practice Address - Phone:203-929-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063278122300000X
CT139881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist