MEDICARE: DR. JAMES STEPHEN SILL D.M.D.

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	122300000X	Dentist	2290	NV

General Provider Information

NPI Number	:	1154367621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES STEPHEN SILL D.M.D.

Provider Business Mailing Address
First Line	:	4890 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3458
Country	:	US
Telephone Number	:	702-649-6859
Fax Number	:

Provider Business Practice Location Address
First Line	:	4890 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3458
Country	:	US
Telephone Number	:	702-649-6859
Fax Number	:

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	04/02/2015

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