Provider Demographics
NPI:1518376649
Name:BRADLEY K. SILVA D.D.S. INC.
Entity Type:Organization
Organization Name:BRADLEY K. SILVA D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-398-8108
Mailing Address - Street 1:51800 HARRISON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1500
Mailing Address - Country:US
Mailing Address - Phone:760-398-8108
Mailing Address - Fax:760-398-8901
Practice Address - Street 1:51800 HARRISON ST STE 1
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1500
Practice Address - Country:US
Practice Address - Phone:760-398-8108
Practice Address - Fax:760-398-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-02
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty