Provider Demographics
NPI:1801085550
Name:CELESTINA, LESLIE (DDS PA)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:CELESTINA
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1212
Mailing Address - Country:US
Mailing Address - Phone:863-382-4894
Mailing Address - Fax:863-382-6715
Practice Address - Street 1:5601 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1212
Practice Address - Country:US
Practice Address - Phone:863-382-4894
Practice Address - Fax:863-382-6715
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60068ZMedicare PIN