Healthcare Provider Details

I. General information

NPI: 1831020676
Provider Name (Legal Business Name): JOSE G SALCEDO HERNANDEZ II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 COMMERCE DR STE 210
LAFAYETTE IN
47905-3823
US

IV. Provider business mailing address

4315 COMMERCE DR STE 210
LAFAYETTE IN
47905-3823
US

V. Phone/Fax

Practice location:
  • Phone: 765-417-7083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12014979A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: