MEDICARE: SILVER FAMILY DENTAL, LLC

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

General Provider Information

NPI Number	:	1346992187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER FAMILY DENTAL, LLC

Provider Business Mailing Address
First Line	:	4812 STATE ROUTE 82
Second Line	:
City	:	MANTUA
State	:	OH
Zip	:	44255-9284
Country	:	US
Telephone Number	:	330-357-8345
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 MAYFIELD RD STE 101
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2611
Country	:	US
Telephone Number	:	216-382-5007
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS ADMINISTRATION
Name	:	THERESA M ROBERTS
Credential	:
Telephone Number	:	330-357-8346

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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