Provider Demographics
NPI:1699167288
Name:MANESS, CELESTE
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:MANESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:KONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:100 E NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-638-5209
Mailing Address - Fax:617-414-1061
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:RM G 612
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-5209
Practice Address - Fax:617-414-1061
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN16979122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics