Healthcare Provider Details

I. General information

NPI: 1619302353
Provider Name (Legal Business Name): JESSICA ANN SILVA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CORONADO CENTER DR SUITE 100
HENDERSON NV
89052-4289
US

IV. Provider business mailing address

1005 WIGWAM PKWY APT. 24106
HENDERSON NV
89074-8247
US

V. Phone/Fax

Practice location:
  • Phone: 702-260-0102
  • Fax: 702-260-0881
Mailing address:
  • Phone: 559-288-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDL12012
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6797
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: