Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 038516 | PA |
N | 122300000X | Dentist | 59904 | CA |
Y | 1223E0200X | Endodontist | 59904 | CA |
N | 1223G0001X | General Practice | DEN10345 | CO |
N | 213EG0000X | General Practice | DEN10345 | CO |
NPI | 1053613968 |
---|---|
Provider Name | Dr. Jenelle Meredith Silvers |
First Address | Redlands, CA 92373-4869 |
Second Address | Redlands, CA 92373-4869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2010 |
Last Update Date | 28/03/2018 |