Provider Demographics
NPI:1821167339
Name:KERELIS, JOVITA M (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JOVITA
Middle Name:M
Last Name:KERELIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 S 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457
Mailing Address - Country:US
Mailing Address - Phone:708-598-8101
Mailing Address - Fax:708-598-8165
Practice Address - Street 1:9525 S 79TH AVE
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2261
Practice Address - Country:US
Practice Address - Phone:708-598-8101
Practice Address - Fax:708-598-8165
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist