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NPI Code Detail

MEDICARE: DR. CHAD STEPHEN SILVERTOOTH D.D.S

MEDICARE: DR. CHAD STEPHEN SILVERTOOTH D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist24062TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
124062OTHERTXTEXAS LICENSE

General Provider Information

NPI Number : 1083877609
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAD STEPHEN SILVERTOOTH D.D.S
Provider Business Mailing Address
First Line : 705 CARLISLE DR
Second Line :
City : KILGORE
State : TX
Zip : 75662-6005
Country : US
Telephone Number : 903-983-1919
Fax Number :
Provider Business Practice Location Address
First Line : 5140 FM 1252 W
Second Line :
City : KILGORE
State : TX
Zip : 75662-1961
Country : US
Telephone Number : 903-983-1919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2008
Last Update Date : 07/04/2008

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Directions to “ DR. CHAD STEPHEN SILVERTOOTH D.D.S” Practice Location

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