Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN19869 | FL |
N | 1223G0001X | General Practice | DN19869 | FL |
N | 213EG0000X | General Practice | DN19869 | FL |
NPI | 1003256868 |
---|---|
Provider Name | Dr. Gladston Silva |
First Address | Daytona Beach, FL 32117-5500 |
Second Address | Daytona Beach, FL 32117-5500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 26/06/2013 |