Provider Demographics
NPI:1023754306
Name:TELLES DA SILVA, VICENTE (DMD)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:
Last Name:TELLES DA SILVA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2936
Mailing Address - Country:US
Mailing Address - Phone:724-389-7898
Mailing Address - Fax:
Practice Address - Street 1:394 RODI RD STE 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3340
Practice Address - Country:US
Practice Address - Phone:412-242-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0434131223X0400X
MD177351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics