Healthcare Provider Details

I. General information

NPI: 1902014343
Provider Name (Legal Business Name): JEFFREY W SILMON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 CARROLL ST STE 1
SHREVEPORT LA
71105-4248
US

IV. Provider business mailing address

230 CARROLL ST STE 1
SHREVEPORT LA
71105-4248
US

V. Phone/Fax

Practice location:
  • Phone: 318-869-1248
  • Fax: 318-869-1504
Mailing address:
  • Phone: 318-869-1248
  • Fax: 318-869-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5506
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: