Healthcare Provider Details

I. General information

NPI: 1265090575
Provider Name (Legal Business Name): CELESTE NACALE GISH-HAMPTON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 RICE ST
WALDRON AR
72958-7435
US

IV. Provider business mailing address

2074 RICE ST
WALDRON AR
72958-7435
US

V. Phone/Fax

Practice location:
  • Phone: 479-307-8760
  • Fax:
Mailing address:
  • Phone: 479-307-8760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1002084-15
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4811
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: