Provider Demographics
NPI:1053470278
Name:SILVERMAN, JACK ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:ROBERT
Last Name:SILVERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8406 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2524
Mailing Address - Country:US
Mailing Address - Phone:440-729-4412
Mailing Address - Fax:440-729-8026
Practice Address - Street 1:8406 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2524
Practice Address - Country:US
Practice Address - Phone:440-729-4412
Practice Address - Fax:440-729-8026
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0129681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice