Provider Demographics
NPI:1184460255
Name:FUENTES-MATTSON, CELESTE AMOR
Entity type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:AMOR
Last Name:FUENTES-MATTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4273 W CIRCLE DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8788
Mailing Address - Country:US
Mailing Address - Phone:507-322-1886
Mailing Address - Fax:
Practice Address - Street 1:4273 W CIRCLE DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8788
Practice Address - Country:US
Practice Address - Phone:507-322-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist