MEDICARE: CELEBRACES CHEYENNE, 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1356034730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELEBRACES CHEYENNE, PLLC

Provider Business Mailing Address
First Line	:	5900 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4203
Country	:	US
Telephone Number	:	702-674-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4203
Country	:	US
Telephone Number	:	702-674-7000
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL ORTHO MANAGER
Name	:	ARIANNA FERRALL
Credential	:
Telephone Number	:	562-397-9279

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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