Provider Demographics
NPI:1124219365
Name:SILVEUS, MICHAEL DOUGLAS (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:SILVEUS
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 1:703 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046
Mailing Address - Country:US
Mailing Address - Phone:703-532-2020
Mailing Address - Fax:703-532-0019
Practice Address - Street 1:703 PARK AVE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3212
Practice Address - Country:US
Practice Address - Phone:703-532-2020
Practice Address - Fax:703-532-0019
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2012-04-23
Deactivation Date:2007-09-11
Deactivation Code:
Reactivation Date:2012-04-23
Provider Licenses
StateLicense IDTaxonomies
VA04010068221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice