Provider Demographics
NPI:1548673742
Name:SILVA DENTAL PA
Entity type:Organization
Organization Name:SILVA DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-274-2021
Mailing Address - Street 1:1667 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5500
Mailing Address - Country:US
Mailing Address - Phone:386-274-2021
Mailing Address - Fax:386-274-1743
Practice Address - Street 1:1667 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5500
Practice Address - Country:US
Practice Address - Phone:386-274-2021
Practice Address - Fax:386-274-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19869261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental