Provider Demographics
NPI:1134737026
Name:CALVO HERNANDEZ, GELSY
Entity type:Individual
Prefix:
First Name:GELSY
Middle Name:
Last Name:CALVO HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 W 101ST PL
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-7703
Mailing Address - Country:US
Mailing Address - Phone:585-287-0199
Mailing Address - Fax:
Practice Address - Street 1:1519 US HIGHWAY 41 STE B8
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1373
Practice Address - Country:US
Practice Address - Phone:219-319-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist