MEDICARE: CHELSEA ELIZABETH CORONADO RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	020015851	IL

General Provider Information

NPI Number	:	1275118796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA ELIZABETH CORONADO RDH

Provider Business Mailing Address
First Line	:	3386 RYAN DR
Second Line	:
City	:	YORKVILLE
State	:	IL
Zip	:	60560-4658
Country	:	US
Telephone Number	:	630-520-3260
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 E CHICAGO AVE STE 344
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5360
Country	:	US
Telephone Number	:	630-778-9500
Fax Number	:	630-778-9521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	03/16/2021

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