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General NPI Number Information
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NPI Number | 1104095520
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Entity Type | Individual
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Provider Name | CELSO FERNANDO PALMIERI
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Gender | Male
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1541 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4228
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Country | US
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Telephone | 318-626-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 1541 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4228
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Country | US
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Telephone | 318-626-0177
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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 | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 7147
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7147
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License Number State | LA
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