Healthcare Provider Details

I. General information

NPI: 1821703802
Provider Name (Legal Business Name): CELEBRACES CLINTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 E OHIO ST
CLINTON MO
64735-2306
US

IV. Provider business mailing address

906 E OHIO ST
CLINTON MO
64735-2306
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-6114
  • Fax:
Mailing address:
  • Phone: 660-885-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA ESLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-459-0000