Provider Demographics
NPI:1659732824
Name:DA SILVA, FREDERICO DUARTE (DDS)
Entity type:Individual
Prefix:
First Name:FREDERICO
Middle Name:DUARTE
Last Name:DA SILVA
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 1:3810 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-5154
Mailing Address - Country:US
Mailing Address - Phone:352-999-4866
Mailing Address - Fax:
Practice Address - Street 1:1005 LONG PRAIRIE RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4232
Practice Address - Country:US
Practice Address - Phone:352-999-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics