Provider Demographics
NPI:1891312484
Name:DA SILVA, CARLOS (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:DA SILVA
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 1:416 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5529
Mailing Address - Country:US
Mailing Address - Phone:954-457-8288
Mailing Address - Fax:
Practice Address - Street 1:8201B NW 88TH AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1500
Practice Address - Country:US
Practice Address - Phone:954-726-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist