Provider Demographics
NPI:1114056835
Name:VARNEDOE, CELESTINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CELESTINE
Middle Name:
Last Name:VARNEDOE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CELESTINE
Other - Middle Name:VARNEDOE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2009 TEBEAU STREET
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501
Mailing Address - Country:US
Mailing Address - Phone:912-283-1340
Mailing Address - Fax:912-283-0334
Practice Address - Street 1:2009 TEBEAU STREET
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501
Practice Address - Country:US
Practice Address - Phone:912-283-1340
Practice Address - Fax:912-283-0334
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice