Provider Demographics
NPI:1013161074
Name:SILOS, NERISSA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:NERISSA
Middle Name:B
Last Name:SILOS
Suffix:
Gender:F
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:P.O. BOX 7643
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-7643
Mailing Address - Country:US
Mailing Address - Phone:671-646-6510
Mailing Address - Fax:671-649-4993
Practice Address - Street 1:#138 YPAO ROAD
Practice Address - Street 2:POLYCLINIC BUILDING
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-646-6510
Practice Address - Fax:671-649-4993
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD-5451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice