Healthcare Provider Details

I. General information

NPI: 1013316983
Provider Name (Legal Business Name): MATTHEW SILVER D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2014
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PENN AVE
WYOMISSING PA
19610-2140
US

IV. Provider business mailing address

630 PUGH RD
WAYNE PA
19087-1909
US

V. Phone/Fax

Practice location:
  • Phone: 203-858-0767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS041232
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: