Healthcare Provider Details

I. General information

NPI: 1518133149
Provider Name (Legal Business Name): CLEBER P SILVA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2008
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 THE FELLSWAY
NEW PROVIDENCE NJ
07974-2353
US

IV. Provider business mailing address

129 THE FELLSWAY
NEW PROVIDENCE NJ
07974-2353
US

V. Phone/Fax

Practice location:
  • Phone: 908-656-1401
  • Fax:
Mailing address:
  • Phone: 908-656-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberNY-047958
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number22DI02088500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: