Provider Demographics
NPI:1760513782
Name:SALVATORIELLO, FRED WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:WILLIAM
Last Name:SALVATORIELLO
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 1:38 E WHEELOCK ST
Mailing Address - Street 2:PO BOX 181
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1515
Mailing Address - Country:US
Mailing Address - Phone:603-643-2176
Mailing Address - Fax:603-643-2176
Practice Address - Street 1:3 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2121
Practice Address - Country:US
Practice Address - Phone:603-643-2176
Practice Address - Fax:603-643-2176
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0001878Medicaid