Provider Demographics
NPI:1336936087
Name:SILLIVENT, AMBER ELISSE (DMD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:ELISSE
Last Name:SILLIVENT
Suffix:
Gender:X
Credentials:DMD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:ELISSE
Other - Last Name:BELANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2946 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6032
Mailing Address - Country:US
Mailing Address - Phone:770-365-0237
Mailing Address - Fax:
Practice Address - Street 1:4226 HARTLEY BRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-4116
Practice Address - Country:US
Practice Address - Phone:478-621-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist