MEDICARE: DR. CELESTE DESIREE MORENO DDS

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	40206	TX

General Provider Information

NPI Number	:	1801591755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CELESTE DESIREE MORENO DDS

Provider Business Mailing Address
First Line	:	6729 BRIDGE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-0817
Country	:	US
Telephone Number	:	214-828-8215
Fax Number	:

Provider Business Practice Location Address
First Line	:	6729 BRIDGE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-0817
Country	:	US
Telephone Number	:	817-799-5961
Fax Number	:

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

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	02/13/2024

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