Healthcare Provider Details

I. General information

NPI: 1225996945
Provider Name (Legal Business Name): CELEBRACES SUNRISE LOVELAND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 E BONANZA RD STE 124
LAS VEGAS NV
89110-3561
US

IV. Provider business mailing address

5001 E BONANZA RD STE 124
LAS VEGAS NV
89110-3561
US

V. Phone/Fax

Practice location:
  • Phone: 702-756-7000
  • Fax:
Mailing address:
  • Phone: 702-756-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KELCEY GORDON LOVELAND
Title or Position: ORTHODONTIST
Credential: DMD, MS
Phone: 702-756-7000