Provider Demographics
NPI:1205460334
Name:CELEBRACES DECATUR LOVELAND PLLC
Entity type:Organization
Organization Name:CELEBRACES DECATUR LOVELAND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIC TREATMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-397-9279
Mailing Address - Street 1:4880 W FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3704
Mailing Address - Country:US
Mailing Address - Phone:702-687-7000
Mailing Address - Fax:
Practice Address - Street 1:4880 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3704
Practice Address - Country:US
Practice Address - Phone:702-687-7000
Practice Address - Fax:702-947-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750896783OtherNPPES