MEDICARE: CELEBRACES SUNRISE LOVELAND PLLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1225996945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELEBRACES SUNRISE LOVELAND PLLC

Provider Business Mailing Address
First Line	:	5001 E BONANZA RD STE 124
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3561
Country	:	US
Telephone Number	:	702-756-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 E BONANZA RD STE 124
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3561
Country	:	US
Telephone Number	:	702-756-7000
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	KELCEY GORDON LOVELAND
Credential	:	DMD, MS
Telephone Number	:	702-756-7000

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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