Healthcare Provider Details

I. General information

NPI: 1720341704
Provider Name (Legal Business Name): JEREMY A SILVERMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 W CHANDLER BLVD STE 2
CHANDLER AZ
85225-2531
US

IV. Provider business mailing address

936 W CHANDLER BLVD STE 2
CHANDLER AZ
85225-2531
US

V. Phone/Fax

Practice location:
  • Phone: 480-608-5444
  • Fax: 480-608-5445
Mailing address:
  • Phone: 480-608-5444
  • Fax: 480-608-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD008467
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: