Provider Demographics
NPI:1164551404
Name:SILVERMAN, KEITH FRED (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:FRED
Last Name:SILVERMAN
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 1:40 W 86TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3605
Mailing Address - Country:US
Mailing Address - Phone:212-877-5370
Mailing Address - Fax:
Practice Address - Street 1:40 W 86TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3605
Practice Address - Country:US
Practice Address - Phone:212-877-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04009-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist