Provider Demographics
NPI:1720223860
Name:MARIA R. SILVERA PORTACIO PHD, DDS, INC.
Entity Type:Organization
Organization Name:MARIA R. SILVERA PORTACIO PHD, DDS, INC.
Other - Org Name:SANTA MARIA PERIODONTICS, DENTAL PRACTICE OF MARIA R. SILVERA PORTACIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SILVERA PORTACIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, DDS
Authorized Official - Phone:805-928-7979
Mailing Address - Street 1:210 S PALISADE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8900
Mailing Address - Country:US
Mailing Address - Phone:805-928-7979
Mailing Address - Fax:805-928-7955
Practice Address - Street 1:210 S PALISADE DR STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8900
Practice Address - Country:US
Practice Address - Phone:805-928-7979
Practice Address - Fax:805-928-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53563261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental