Provider Demographics
NPI:1629708136
Name:RATHMELL, CELIA ANDREA (DDS)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:ANDREA
Last Name:RATHMELL
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 1:2203 ONION CREEK PKWY UNIT 17
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-1650
Mailing Address - Country:US
Mailing Address - Phone:956-750-2235
Mailing Address - Fax:
Practice Address - Street 1:201 W 5TH ST STE 175
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2951
Practice Address - Country:US
Practice Address - Phone:512-647-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty