Provider Demographics
NPI:1740633270
Name:LOVE, CELESTE (DMD)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:LOVE
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 1:4701 PITT ST
Mailing Address - Street 2:APT D
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4055
Mailing Address - Country:US
Mailing Address - Phone:404-663-5989
Mailing Address - Fax:
Practice Address - Street 1:12519 AIRLINE HWY STE G
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-2502
Practice Address - Country:US
Practice Address - Phone:985-764-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA67101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice