Provider Demographics
NPI:1619406857
Name:LAMACCHIA, JELENA (DDS)
Entity type:Individual
Prefix:DR
First Name:JELENA
Middle Name:
Last Name:LAMACCHIA
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 1:23963 N 77TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6153
Mailing Address - Country:US
Mailing Address - Phone:262-960-2783
Mailing Address - Fax:
Practice Address - Street 1:8438 E SHEA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6669
Practice Address - Country:US
Practice Address - Phone:480-661-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0097701223G0001X
AZD0097701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice