Healthcare Provider Details

I. General information

NPI: 1477604387
Provider Name (Legal Business Name): STEVEN WAYNE SILVERBERG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 MINERAL SPRING AVENUE SUITE 219
NORTH PROVIDENCE RI
02904
US

IV. Provider business mailing address

1637 MINERAL SPRING AVENUE SUITE 219
NORTH PROVIDENCE RI
02904
US

V. Phone/Fax

Practice location:
  • Phone: 401-354-6565
  • Fax: 401-354-0044
Mailing address:
  • Phone: 401-354-6565
  • Fax: 401-354-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1905
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14424
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: