Provider Demographics
NPI:1619045374
Name:LESLIE CELESTINA DDS PA
Entity Type:Organization
Organization Name:LESLIE CELESTINA DDS PA
Other - Org Name:HEARTLAND ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CELESTINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:863-382-4894
Mailing Address - Street 1:5601 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1212
Mailing Address - Country:US
Mailing Address - Phone:863-383-4894
Mailing Address - Fax:863-382-6715
Practice Address - Street 1:5601 US HWY 27 NORTH
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1212
Practice Address - Country:US
Practice Address - Phone:863-383-4894
Practice Address - Fax:863-382-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 155451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5794Medicare PIN
FLU99972Medicare UPIN