Individual provider Active NPI

Celeste Ruhia Cornell-Valdes, DDS

  • General Practice Dentistry
  • Fort Gratiot, MI
National Provider Identifier
1366488330
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901018276 Issued in MI
Practice address
4036 24TH Ave
Fort Gratiot, MI 48059-3800
Phone
(810) 385-9766
Fax
(810) 385-4161
NPI assigned
Jun 20, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901018276 MI Primary

Addresses

Primary practice location

4036 24TH Ave
Fort Gratiot, MI 48059-3800

Mailing address

4036 24TH Ave
Fort Gratiot, MI 48059-3800
Phone (810) 385-9766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160328000919 MI Order and Referring Only - DentistPractitioner - Dentist 3476863630

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901018276MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Valcor Dental Center PC General Practice PastSince Sep 3, 2003 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366488330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4036 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593800",
            "telephone_number": "810-385-9766",
            "fax_number": "810-385-4161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4036 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593800",
            "telephone_number": "810-385-9766",
            "fax_number": "810-385-4161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELL-VALDES",
        "first_name": "CELESTE",
        "middle_name": "RUHIA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Gratiot, MI

Sources for this page

Verify at the official NPI Registry.