MEDICARE: DR. CELESTE A. LANTIS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	18501	TX

General Provider Information

NPI Number	:	1194012559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CELESTE A. LANTIS D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 860036
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55486-0036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2373 LEN PATTERSON RD STE 103
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8266
Country	:	US
Telephone Number	:	803-752-0655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/20/2021

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Directions to “ DR. CELESTE A. LANTIS D.D.S.” Practice Location

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