Provider Demographics
NPI:1255330304
Name:SILVA, RICHARD EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
Last Name:SILVA
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 1:774 DELNERO DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5223
Mailing Address - Country:US
Mailing Address - Phone:209-532-4401
Mailing Address - Fax:209-532-9089
Practice Address - Street 1:774 DELNERO DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5223
Practice Address - Country:US
Practice Address - Phone:209-532-4401
Practice Address - Fax:209-532-9089
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CA301531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice