Provider Demographics
NPI:1417699612
Name:BARBONE, CELES (RDH)
Entity Type:Individual
Prefix:
First Name:CELES
Middle Name:
Last Name:BARBONE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2071
Mailing Address - Street 2:
Mailing Address - City:CROWNPOINT
Mailing Address - State:NM
Mailing Address - Zip Code:87313-2071
Mailing Address - Country:US
Mailing Address - Phone:505-320-2263
Mailing Address - Fax:
Practice Address - Street 1:1748 W MALONEY AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-3333
Practice Address - Country:US
Practice Address - Phone:505-863-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH4434124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist