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General NPI Number Information
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NPI Number | 1366598518
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Entity Type | Organization
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Legal Business Name | IRVIN B. SILVERSTEIN, D.D.S., M.S.ED. A PROFESSIONAL CORPORTATION
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6080 LAKE MURRAY BLVD SUITE A
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City | LA MESA
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State | CA
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Zip | 91942-2572
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Country | US
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Telephone | 619-466-6666
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Fax | 619-466-2639
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Provider Business Mailing Address
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Address Line | 6080 LAKE MURRAY BLVD SUITE A
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City | LA MESA
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State | CA
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Zip | 91942-2572
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Country | US
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Telephone | 619-466-6666
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Fax | 619-466-2639
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRVIN BARRY SILVERSTEIN
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Credential | D.D.S., M.S.ED.
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Telephone | 619-466-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 27838
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License Number State | CA
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