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General NPI Number Information
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NPI Number | 1134737026
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Entity Type | Individual
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Provider Name | GELSY CALVO HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 1519 US HIGHWAY 41 STE B8
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City | SCHERERVILLE
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State | IN
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Zip | 46375-1373
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Country | US
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Telephone | 219-319-0108
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Fax |
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Provider Business Mailing Address
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Address Line | 8455 W 101ST PL
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City | SAINT JOHN
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State | IN
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Zip | 46373-7703
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Country | US
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Telephone | 585-287-0199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019032808
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License Number State | IL
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