Healthcare Provider Details

I. General information

NPI: 1396574836
Provider Name (Legal Business Name): CELEITH YANETH ACEVEDO MOROS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CELEITH ACEVEDO MOROS DDS

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MANCHESTER AVE
DERRY NH
03038-1931
US

IV. Provider business mailing address

189 WASHINGTON AVE APT 3
CHELSEA MA
02150-3928
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-3898
  • Fax:
Mailing address:
  • Phone: 206-596-1521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDL101828
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number05407
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: