1982613733 NPI number — DR. LENA DIANE KARKALAS DDS

Table of content: DR. LENA DIANE KARKALAS DDS (NPI 1982613733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982613733 NPI number — DR. LENA DIANE KARKALAS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARKALAS
Provider First Name:
LENA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERWITZ
Provider Other First Name:
LENA
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1982613733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 WATERMAN ST
Provider Second Line Business Mailing Address:
UNIT #3
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02906-2118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-861-2140
Provider Business Mailing Address Fax Number:
401-861-3010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 WATERMAN ST
Provider Second Line Business Practice Location Address:
UNIT #3
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02906-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-861-2140
Provider Business Practice Location Address Fax Number:
401-861-3010
Provider Enumeration Date:
08/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  02678 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)