Healthcare Provider Details

I. General information

NPI: 1053228965
Provider Name (Legal Business Name): LENA MATTI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31207 RYAN RD
WARREN MI
48092-3761
US

IV. Provider business mailing address

40532 RIVERBEND DR
STERLING HEIGHTS MI
48310-6992
US

V. Phone/Fax

Practice location:
  • Phone: 586-553-9399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603288
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: