Provider Demographics
NPI:1245388552
Name:CELIS, JOSE ALEJANDRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:CELIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DOUGLASS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1408
Mailing Address - Country:US
Mailing Address - Phone:415-264-0838
Mailing Address - Fax:408-262-9998
Practice Address - Street 1:991 MONTAGUE EXPY
Practice Address - Street 2:SUITE# 211
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6818
Practice Address - Country:US
Practice Address - Phone:408-262-9999
Practice Address - Fax:408-262-9998
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-4599983OtherTAX ID NUMBER