Provider Demographics
NPI:1952568222
Name:ECKERMAN, CELESTE MARIE (DDS)
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:MARIE
Last Name:ECKERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 LAKE TAHOE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6407
Mailing Address - Country:US
Mailing Address - Phone:530-541-4640
Mailing Address - Fax:530-541-3853
Practice Address - Street 1:2074 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6407
Practice Address - Country:US
Practice Address - Phone:530-541-4640
Practice Address - Fax:530-541-3853
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA562851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice