Provider Demographics
NPI:1477604387
Name:SILVERBERG, STEVEN WAYNE (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:SILVERBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 MINERAL SPRING AVENUE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-354-6565
Mailing Address - Fax:401-354-0044
Practice Address - Street 1:1637 MINERAL SPRING AVENUE
Practice Address - Street 2:SUITE 219
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-354-6565
Practice Address - Fax:401-354-0044
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI19051223X0400X
MA144241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI84916OtherBLUE CROSS OF RI
RISS11875Medicaid
MAX06781OtherBLUE CROSS OF MA