Provider Demographics
NPI:1417084310
Name:SILVEIRA, MARILICE A (DDS)
Entity Type:Individual
Prefix:
First Name:MARILICE
Middle Name:A
Last Name:SILVEIRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 W LA VIDA DR
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9220
Mailing Address - Country:US
Mailing Address - Phone:559-738-1657
Mailing Address - Fax:
Practice Address - Street 1:888 N ALTA AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-3089
Practice Address - Country:US
Practice Address - Phone:559-595-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice