Provider Demographics
NPI:1912044470
Name:SILVIUS, CHARLES LEWIS III (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEWIS
Last Name:SILVIUS
Suffix:III
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 1:34 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-5110
Mailing Address - Country:US
Mailing Address - Phone:781-286-3700
Mailing Address - Fax:781-286-8534
Practice Address - Street 1:34 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-5110
Practice Address - Country:US
Practice Address - Phone:781-286-3700
Practice Address - Fax:781-286-8534
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice