Provider Demographics
NPI:1144754631
Name:RIVOLI, SALVATORE (DDS)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
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:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-0120
Mailing Address - Country:US
Mailing Address - Phone:585-278-1000
Mailing Address - Fax:585-352-3211
Practice Address - Street 1:77 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-2156
Practice Address - Country:US
Practice Address - Phone:585-278-1000
Practice Address - Fax:585-352-3211
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024620-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics