Provider Demographics
NPI:1568453363
Name:SILVERMAN, MITCHELL B (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:B
Last Name:SILVERMAN
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 1:8216 LOUISIANA BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2105
Mailing Address - Country:US
Mailing Address - Phone:505-822-1234
Mailing Address - Fax:505-856-0460
Practice Address - Street 1:8216 LOUISIANA BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2105
Practice Address - Country:US
Practice Address - Phone:505-822-1234
Practice Address - Fax:505-856-0460
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD22271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12768Medicaid