MEDICARE: DR. JOHN DAREN DA SILVA D.M.D

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	1223P0700X	Prosthodontics	16484	MA

General Provider Information

NPI Number	:	1932116068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAREN DA SILVA D.M.D

Provider Business Mailing Address
First Line	:	196 CHESTNUT AVE
Second Line	:	UNIT M
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4446
Country	:	US
Telephone Number	:	617-432-1440
Fax Number	:	617-432-3881

Provider Business Practice Location Address
First Line	:	188 LONGWOOD AVE
Second Line	:	SUITE 206F
City	:	BOSTON
State	:	MA
Zip	:	02115-5819
Country	:	US
Telephone Number	:	617-432-1440
Fax Number	:	617-432-3881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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