Provider Demographics
NPI:1295861615
Name:LONGORIA, CELINA M (DDS)
Entity Type:Individual
Prefix:MRS
First Name:CELINA
Middle Name:M
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15210 SPRING CYPRESS RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6407
Mailing Address - Country:US
Mailing Address - Phone:281-213-8700
Mailing Address - Fax:281-256-9685
Practice Address - Street 1:15210 SPRING CYPRESS RD
Practice Address - Street 2:SUITE G
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6407
Practice Address - Country:US
Practice Address - Phone:281-213-8700
Practice Address - Fax:281-256-9685
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
88D738OtherBCBS
1327993OtherUNITED CONCORDIA