Provider Demographics
NPI:1356962435
Name:CHILDS, GERALD WAYNE JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WAYNE
Last Name:CHILDS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3030
Mailing Address - Country:US
Mailing Address - Phone:219-381-0026
Mailing Address - Fax:
Practice Address - Street 1:6 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5446
Practice Address - Country:US
Practice Address - Phone:219-472-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013543A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist