Individual provider Active NPI

David Thomas Celello, D.M.D.

  • General Practice Dentistry
  • Louisville, KY
National Provider Identifier
1508050907
Registry record updated Oct 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8547 Issued in KY
Practice address
718 Lyndon LN
Suite #1
Louisville, KY 40222-4642
Phone
(502) 425-2990
NPI assigned
Aug 29, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2008

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 8547 KY Primary

Addresses

Primary practice location

718 Lyndon LN
Suite #1
Louisville, KY 40222-4642

Mailing address

718 Lyndon LN
Suite #1
Louisville, KY 40222-4642
Phone (502) 425-2990

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20150129001030 KY Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 1951580992

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8547KYMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223337600000",
    "number": "1508050907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 LYNDON LN",
            "address_2": "SUITE #1",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402224642",
            "telephone_number": "502-425-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 LYNDON LN",
            "address_2": "SUITE #1",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402224642",
            "telephone_number": "502-425-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CELELLO",
        "first_name": "DAVID",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-29",
        "last_updated": "2008-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "8547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.