MEDICARE: DR. CELESTE NICOLE STUART DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6562	AL
2	1223G0001X	General Practice Dentistry	204970	CO
3	1223G0001X	General Practice Dentistry	DB-2023-0032	NM
4	1223G0001X	General Practice Dentistry	D011982	AZ

General Provider Information

NPI Number	:	1205313087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CELESTE NICOLE STUART DMD

Provider Business Mailing Address
First Line	:	13 ZETA ST
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-4962
Country	:	US
Telephone Number	:	251-591-9871
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 FRONTAGE RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8154
Country	:	US
Telephone Number	:	928-704-0220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	04/08/2024

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