Healthcare Provider Details

I. General information

NPI: 1750397626
Provider Name (Legal Business Name): CELESTINE K FERNANDEZ-VIVES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 US HIGHWAY 130 SUITE 6
ROBBINSVILLE NJ
08691-1137
US

IV. Provider business mailing address

1140 US HIGHWAY 130 SUITE 6
ROBBINSVILLE NJ
08691-1137
US

V. Phone/Fax

Practice location:
  • Phone: 609-450-8890
  • Fax: 609-585-8112
Mailing address:
  • Phone: 609-450-8890
  • Fax: 609-585-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2314100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: