Healthcare Provider Details

I. General information

NPI: 1407760721
Provider Name (Legal Business Name): DIEGO BARBOSA DA SILVA IPDH, RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAIN ST
GORHAM ME
04038-1319
US

IV. Provider business mailing address

3137 ROUTE 114
BRADFORD NH
03221-4255
US

V. Phone/Fax

Practice location:
  • Phone: 781-518-1334
  • Fax:
Mailing address:
  • Phone: 781-518-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH4679
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: