MEDICARE: DR. CELESTE C MORTENSON 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	7364168-9922	UT

General Provider Information

NPI Number	:	1972734515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CELESTE C MORTENSON DDS

Provider Business Mailing Address
First Line	:	202 N GATEWAY DR
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9001
Country	:	US
Telephone Number	:	435-752-0605
Fax Number	:	435-755-8574

Provider Business Practice Location Address
First Line	:	202 N GATEWAY DR
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9001
Country	:	US
Telephone Number	:	435-752-0605
Fax Number	:	435-755-8574

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

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	01/14/2026

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