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General NPI Number Information
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NPI Number | 1659732824
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Entity Type | Individual
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Provider Name | FREDERICO DUARTE DA SILVA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 1005 LONG PRAIRIE RD STE 100
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4232
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Country | US
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Telephone | 352-999-4866
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Fax |
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Provider Business Mailing Address
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Address Line | 3810 IRONWOOD DR
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City | PROSPER
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State | TX
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Zip | 75078-5154
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Country | US
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Telephone | 352-999-4866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 35707
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License Number State | TX
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