Provider Demographics
NPI:1063558286
Name:CELKO, RICHARD M (DMD,MBA)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:CELKO
Suffix:
Gender:M
Credentials:DMD,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2402
Mailing Address - Country:US
Mailing Address - Phone:412-875-7635
Mailing Address - Fax:412-875-7699
Practice Address - Street 1:2314 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2402
Practice Address - Country:US
Practice Address - Phone:412-875-7635
Practice Address - Fax:412-875-7699
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026767 L122300000X
NMDD2559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist