Provider Demographics
NPI:1659311249
Name:SILVA, BRUCE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:SILVA
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 1:518 E OLTORF ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5639
Mailing Address - Country:US
Mailing Address - Phone:512-442-6728
Mailing Address - Fax:512-442-7768
Practice Address - Street 1:518 E OLTORF ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5639
Practice Address - Country:US
Practice Address - Phone:512-442-6728
Practice Address - Fax:512-442-7768
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700314702OtherGEHA
TXD13224OtherBLUE CROSS BLUE SHIELD
MOPR092985OtherDELTA DENTAL