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General NPI Number Information
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NPI Number | 1043866049
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Entity Type | Individual
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Provider Name | CELESTE ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 08/15/2019
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 1550 TOMCAT BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23460-2218
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Country | US
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Telephone | 757-953-3925
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Fax |
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Provider Business Mailing Address
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Address Line | 252 N WINNEBAGO DR
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City | LAKE WINNEBAGO
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State | MO
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Zip | 64034-9319
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2019030279
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License Number State | MO
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