Healthcare Provider Details

I. General information

NPI: 1366733487
Provider Name (Legal Business Name): PUBLIO SILFA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2011
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 21ST ST 2ND FLOOR
ASTORIA NY
11102-4242
US

IV. Provider business mailing address

3080 21ST ST 2ND FLOOR
ASTORIA NY
11102-4242
US

V. Phone/Fax

Practice location:
  • Phone: 718-873-9550
  • Fax: 718-228-4591
Mailing address:
  • Phone: 718-873-9550
  • Fax: 718-228-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number056071
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: