1336936087 NPI number — DR. AMBER ELISSE SILLIVENT DMD

Table of content: DR. AMBER ELISSE SILLIVENT DMD (NPI 1336936087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336936087 NPI number — DR. AMBER ELISSE SILLIVENT DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILLIVENT
Provider First Name:
AMBER
Provider Middle Name:
ELISSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
X

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELANGER
Provider Other First Name:
AMBER
Provider Other Middle Name:
ELISSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336936087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2946 ARROWHEAD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30909-6032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-365-0237
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4226 HARTLEY BRIDGE RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31216-4116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-621-7657
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN123760 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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