| Doctor Name: | CELESTE SERVO |
| NPI Number: | 1033491907 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1900 Mcloughlin Blvd Ste 68 Oregon City, OR - 970451072 |
| Business Phone Number: | 5093878000 |
| Business Fax Number: | |
| Mailing Address: | 1900 Mcloughlin Blvd Ste 68, OREGON CITY |
| State: | OR |
| Postal Code: | 970451072 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/15/2011 |
| NPI Last Update Date: | 11/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |