MEDICARE: CELINA LIEZL JIMENEZ DELEON 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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	8179	NV

General Provider Information

NPI Number	:	1699589309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELINA LIEZL JIMENEZ DELEON DMD

Provider Business Mailing Address
First Line	:	1001 SHADOW LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3675 S RAINBOW BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1059
Country	:	US
Telephone Number	:	702-602-2196
Fax Number	:

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

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	08/19/2025

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Directions to “ CELINA LIEZL JIMENEZ DELEON DMD” Practice Location

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