Healthcare Provider Details

I. General information

NPI: 1396349171
Provider Name (Legal Business Name): RAUL J SILVERA HERNANDEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 N WEBER RD
BOLINGBROOK IL
60490-1567
US

IV. Provider business mailing address

358 LEICESTER CT
BOLINGBROOK IL
60440-2117
US

V. Phone/Fax

Practice location:
  • Phone: 630-759-3595
  • Fax:
Mailing address:
  • Phone: 407-800-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037236
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: