Provider Demographics
NPI:1104140201
Name:SILVA OSEGUERA, ANTONIO (DDS)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:SILVA OSEGUERA
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 1:5601 E CALEY AVE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4202
Mailing Address - Country:US
Mailing Address - Phone:303-934-4285
Mailing Address - Fax:
Practice Address - Street 1:1200 S WADSWORTH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5473
Practice Address - Country:US
Practice Address - Phone:303-934-4285
Practice Address - Fax:720-458-3916
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99111223X0400X
TX241151223X0400X
LA60851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41920783Medicaid