Provider Demographics
NPI:1720400021
Name:FENELL, CELIA E (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CELIA
Middle Name:E
Last Name:FENELL
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8155 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2164
Mailing Address - Country:US
Mailing Address - Phone:440-479-6019
Mailing Address - Fax:
Practice Address - Street 1:11850 MAYFIELD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-8370
Practice Address - Country:US
Practice Address - Phone:440-214-9118
Practice Address - Fax:440-214-9174
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0234741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics