Healthcare Provider Details

I. General information

NPI: 1316856370
Provider Name (Legal Business Name): SILVER SPRING IMPLANT & ORAL SURGERY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SPRING ST STE 140
SILVER SPRING MD
20910-3616
US

IV. Provider business mailing address

1300 SPRING ST STE 140
SILVER SPRING MD
20910-3616
US

V. Phone/Fax

Practice location:
  • Phone: 227-229-0199
  • Fax: 227-229-0199
Mailing address:
  • Phone: 227-229-0199
  • Fax: 227-229-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA WIETH
Title or Position: DIRECTOR OF PAYOR RELATIONS
Credential:
Phone: 623-267-8121