Provider Demographics
NPI:1679689830
Name:LENA, JULIANN MICHELE (RDA)
Entity type:Individual
Prefix:MISS
First Name:JULIANN
Middle Name:MICHELE
Last Name:LENA
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 EASTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-2124
Mailing Address - Country:US
Mailing Address - Phone:408-981-4220
Mailing Address - Fax:
Practice Address - Street 1:3860 EASTWOOD CIR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-2124
Practice Address - Country:US
Practice Address - Phone:408-981-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64217126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant