Provider Demographics
NPI:1194414268
Name:SILVER FOREST DENTAL PLLC
Entity type:Organization
Organization Name:SILVER FOREST DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-303-1528
Mailing Address - Street 1:60 SILVER FOREST DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3838
Mailing Address - Country:US
Mailing Address - Phone:904-640-8288
Mailing Address - Fax:
Practice Address - Street 1:60 SILVER FOREST DR STE 104
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3838
Practice Address - Country:US
Practice Address - Phone:904-640-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental