Provider Demographics
NPI:1003256868
Name:SILVA, GLADSTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLADSTON
Middle Name:
Last Name:SILVA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 N CLYDE MORRIS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5500
Mailing Address - Country:US
Mailing Address - Phone:386-274-2021
Mailing Address - Fax:386-274-1743
Practice Address - Street 1:1667 N CLYDE MORRIS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5500
Practice Address - Country:US
Practice Address - Phone:386-274-2021
Practice Address - Fax:386-274-1743
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19869122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice