Provider Demographics
NPI:1205313087
Name:STUART, CELESTE NICOLE (DMD)
Entity type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:NICOLE
Last Name:STUART
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ZETA ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-4962
Mailing Address - Country:US
Mailing Address - Phone:251-591-9871
Mailing Address - Fax:
Practice Address - Street 1:3650 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8154
Practice Address - Country:US
Practice Address - Phone:928-704-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL65621223G0001X
CO2049701223G0001X
NMDB-2023-00321223G0001X
AZD0119821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice