Provider Demographics
NPI:1023356540
Name:KELLY A. SILVA, DDS, PC
Entity type:Organization
Organization Name:KELLY A. SILVA, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-245-3912
Mailing Address - Street 1:132 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-2209
Mailing Address - Country:US
Mailing Address - Phone:120-824-5391
Mailing Address - Fax:120-824-5551
Practice Address - Street 1:132 S 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-2209
Practice Address - Country:US
Practice Address - Phone:120-824-5391
Practice Address - Fax:120-824-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IDD3897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty