Provider Demographics
NPI:1407403652
Name:SILVA SILVEIRA, CHRISTIAN (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:SILVA SILVEIRA
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 1:422 CARL RIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-5730
Mailing Address - Country:US
Mailing Address - Phone:603-820-6080
Mailing Address - Fax:
Practice Address - Street 1:3450 COBB PKWY NW STE 160
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8379
Practice Address - Country:US
Practice Address - Phone:770-222-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122234122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist