MEDICARE: COURTNEY ELIZABETH SILVA

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
1	1223G0001X	General Practice Dentistry	DN1858742	MA
2	1223G0001X	General Practice Dentistry	DEN03606	RI

General Provider Information

NPI Number	:	1093323255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ELIZABETH SILVA

Provider Business Mailing Address
First Line	:	1492 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1492 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3130
Country	:	US
Telephone Number	:	401-353-4880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	07/25/2022

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Directions to “ COURTNEY ELIZABETH SILVA ” Practice Location

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