Provider Demographics
NPI:1902014343
Name:SILMON, JEFFREY W (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:SILMON
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 1:230 CARROLL ST
Mailing Address - Street 2:STE 1
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4248
Mailing Address - Country:US
Mailing Address - Phone:318-869-1248
Mailing Address - Fax:318-869-1504
Practice Address - Street 1:230 CARROLL ST
Practice Address - Street 2:STE 1
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4248
Practice Address - Country:US
Practice Address - Phone:318-869-1248
Practice Address - Fax:318-869-1504
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics