Provider Demographics
NPI:1083794374
Name:RIVOLI, PETER SALVATORE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SALVATORE
Last Name:RIVOLI
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:PO BOX 120
Mailing Address - Street 2:77 NICHOLS STREET
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559
Mailing Address - Country:US
Mailing Address - Phone:585-278-1000
Mailing Address - Fax:585-352-3211
Practice Address - Street 1:77 NICHOLS STREETS
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559
Practice Address - Country:US
Practice Address - Phone:585-278-1000
Practice Address - Fax:585-352-3211
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04020611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics