Provider Demographics
NPI:1174640908
Name:SILVA, JUAN RAFAEL (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:RAFAEL
Last Name:SILVA
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CALLE PONCE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5021
Mailing Address - Country:US
Mailing Address - Phone:787-281-6681
Mailing Address - Fax:787-250-1392
Practice Address - Street 1:6 CALLE PONCE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5021
Practice Address - Country:US
Practice Address - Phone:787-281-6681
Practice Address - Fax:787-250-1392
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19931223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics