Provider Demographics
NPI:1396574836
Name:ACEVEDO MOROS, CELEITH YANETH (DDS)
Entity type:Individual
Prefix:
First Name:CELEITH
Middle Name:YANETH
Last Name:ACEVEDO MOROS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CELEITH
Other - Middle Name:
Other - Last Name:ACEVEDO MOROS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1 KNEELAND ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1527
Mailing Address - Country:US
Mailing Address - Phone:206-596-1521
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL3NS8F283B390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program