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General NPI Number Information
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NPI Number | 1356962435
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Entity Type | Individual
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Provider Name | GERALD WAYNE CHILDS JR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 6 W LINCOLN HWY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5446
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Country | US
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Telephone | 219-472-2275
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 ORIOLE DR
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City | MUNSTER
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State | IN
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Zip | 46321-3030
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Country | US
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Telephone | 219-381-0026
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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 | 12013543A
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License Number State | IN
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