Provider Demographics
NPI:1730234154
Name:MENA, EMMANUELA (DDS)
Entity type:Individual
Prefix:
First Name:EMMANUELA
Middle Name:
Last Name:MENA
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 1:730 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-3103
Mailing Address - Country:US
Mailing Address - Phone:423-209-5800
Mailing Address - Fax:
Practice Address - Street 1:730 E 11TH ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3103
Practice Address - Country:US
Practice Address - Phone:423-209-5800
Practice Address - Fax:423-498-4587
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042603-11223G0001X
TN111781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01182154Medicaid