Provider Demographics
NPI:1063769594
Name:ACOSTA LENIS, CLAUDIA JEANNETTE (DDS)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:JEANNETTE
Last Name:ACOSTA LENIS
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 1:37235 GODDARD
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174
Mailing Address - Country:US
Mailing Address - Phone:734-941-0343
Mailing Address - Fax:734-941-9476
Practice Address - Street 1:37235 GODDARD RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1215
Practice Address - Country:US
Practice Address - Phone:734-941-0343
Practice Address - Fax:734-941-9476
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010207231223G0001X
NMDD44021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice