Provider Demographics
NPI:1619921772
Name:SCIORTINO, SALVATORE A (DDS)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:A
Last Name:SCIORTINO
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 1:1511 BRYN MAWR LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-2523
Mailing Address - Country:US
Mailing Address - Phone:815-398-5106
Mailing Address - Fax:
Practice Address - Street 1:129 S PHELPS AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2453
Practice Address - Country:US
Practice Address - Phone:815-399-2337
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA134531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice