Provider Demographics
NPI:1538587811
Name:SILVERLIGHT DENTAL
Entity type:Organization
Organization Name:SILVERLIGHT DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:832-510-8306
Mailing Address - Street 1:4000 LOUETTA RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4405
Mailing Address - Country:US
Mailing Address - Phone:832-510-8306
Mailing Address - Fax:
Practice Address - Street 1:4000 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4405
Practice Address - Country:US
Practice Address - Phone:832-510-8306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty