Provider Demographics
NPI:1861068033
Name:SILVERMAN, JACLYN
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SILVERMAN
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 1:2151 ROUTE 38 APT 810
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-4231
Mailing Address - Country:US
Mailing Address - Phone:770-547-8087
Mailing Address - Fax:
Practice Address - Street 1:26 KINGS HWY W
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2122
Practice Address - Country:US
Practice Address - Phone:856-429-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02836500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist