Provider Demographics
NPI:1376865667
Name:SILLER, JENNIFER RUTH (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:SILLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E 86TH ST
Mailing Address - Street 2:APARTMENT 4C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1059
Mailing Address - Country:US
Mailing Address - Phone:646-924-8555
Mailing Address - Fax:
Practice Address - Street 1:182 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3206
Practice Address - Country:US
Practice Address - Phone:201-444-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024267001223X0400X
NY0543851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics