Provider Demographics
NPI:1518076322
Name:SILBERBERG, JOHN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:SILBERBERG
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 1:4 REGENCY CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1361
Mailing Address - Country:US
Mailing Address - Phone:636-272-6482
Mailing Address - Fax:636-272-6485
Practice Address - Street 1:2885 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7863
Practice Address - Country:US
Practice Address - Phone:636-272-6482
Practice Address - Fax:636-272-6485
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE 0139291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice