Provider Demographics
NPI:1861124141
Name:DA SILVA, LIVIA (DMD)
Entity type:Individual
Prefix:DR
First Name:LIVIA
Middle Name:
Last Name:DA SILVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10312 BENSON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-2569
Mailing Address - Country:US
Mailing Address - Phone:954-225-7571
Mailing Address - Fax:
Practice Address - Street 1:7451 103RD ST STE 18
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6789
Practice Address - Country:US
Practice Address - Phone:904-777-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist