MEDICARE: SILVER SMILES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DD3693	NM

General Provider Information

NPI Number	:	1801258991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER SMILES PC

Provider Business Mailing Address
First Line	:	612 SATINWOOD LN
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76039-1137
Country	:	US
Telephone Number	:	575-534-7827
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 N BENNETT ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5654
Country	:	US
Telephone Number	:	575-534-3699
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CAYTLYN FOY BONURA
Credential	:	DDS
Telephone Number	:	575-534-7827

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/28/2016

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Directions to “SILVER SMILES PC ” Practice Location

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